Chapter015.ppt

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 15
Community As Client: Applying the
Nursing Process

Community As Client
• A community-wide group of people as the focus of
nursing service
– The community directly influences the health of
individuals, families, groups, subpopulations,
and populations who are a part of it.
– Provision of most health services occurs at the
community level.

Dimensions of Community As Client
• One perspective:
– Status: morbidity & mortality data identifying
physical, emotional, and social determinants of
health
– Structure: services and resources
– Process: ability to function effectively

Dimensions of Community As a Client
(cont.)
• Another perspective:
– Location (community boundaries, location of
health services, geographic features, climate,
flora, fauna, human-made environment)
– Population (size, density, composition, rate of
growth or decline, cultural characteristics, social
class and educational level, mobility)
– Social system (variables, health care delivery
system)

Question
Is the following statement true or false?
• Most health services occur at the individual level.

Answer
• False
– Most health services are provided at the
community level.

Nursing Process Characteristics &
Community
• Problem-solving process; management process;
process for implementing change
• Characteristics:
– Deliberative; adaptable; cyclic
– Client-focused; need-oriented
– Interaction with community (communication,
reciprocal interaction, paving way for helping
relationship, aggregate application)
– Forming of partnerships and building of
coalitions

Community Needs Assessment
• Process of determining real or perceived needs of a
defined community
• Types
– Windshield survey (familiarization assessment)
– Problem-oriented assessment
– Community subsystem assessment
– Comprehensive assessment (key informants)
– Community assets assessment

Community Assessment Methods
• Surveys
• Descriptive epidemiologic studies
• Community forums/town hall meetings
• Focus groups

Sources of Community Data
• Primary: gathered by talking to the people
• Secondary: records produced by people who know
the community well
• International
• National
• State
• Local

Data Analysis and Diagnosis
• Validation of data  data interpretation
• Diagnosis

Question
• An epidemiologic study is one type of community
assessment.

Answer
• False
– An epidemiologic study is a method for
completing a community assessment.

Community Diagnoses
• Portray a community focus
• Include community response and related factors that have
potential for change via CHN; logically consistent; response
and factors logically linked
• Include statements narrow enough to guide interventions
• Use a community response instead of a risk, goal, or need
statement
• Include factors within the domain of community health
nursing intervention
• Deficit and wellness diagnoses (include maintenance or
potential change responses due to growth and development)
when no deficit is present

Planning to Meet Community Health
Needs; Implementing Plans
• Planning
– Tools for assistance: operational definitions of
objectives and activities, conceptual frameworks
and models; systematic approach
– Health planning process
• Implementing
– Preparation
– Activities or actions

Evaluating Implemented Community
Health Plan
• Measuring or judging effectiveness of goal or
outcome attainment
• Types of evaluation
– Formative: focus on process during actual
interventions; development of performance
standards
– Summative: focus on the outcomes of
interventions; effect; impact

Community Development Theory
• Outcome of effective community-level nursing
practice
• Collaboration with community members to assess
collective needs and desires for positive change and
address these needs through problem solving, use
of community experts, and resource development
• Presumption that all community members
participate in all aspects of change
• Agent of change (nurse) considered a partner, not
authority figure responsible for community’s health
• Outcomes benchmarked against those of other
groups

Question
• A formative evaluation focuses on the outcomes of
the interventions.

Answer
• False
– A formative evaluation focuses on the process
during the actual interventions.

Internet Resources
• Agency for Toxic Substances and Disease Registry:
http://www.atsdr.cdc.gov
• National Health Information Center:
http://health.gov/nhic
• National Institute of Environmental Health Sciences:
http://www.niehs.nih.gov
• National Institutes of Health: http://www.nih.gov
• National Safety Council: http://www.nsc.org
• Office of Disease Prevention:
http://www.odphp.osophs.dhhs.gov

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