Chapter 6Community AssessmentCopyright © 2015, 2011, 2007, 2.docx

Chapter 6
Community Assessment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
Defining the Community
Aggregate of people
The “who”
Share personal characteristics and risks
Location in space and time
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
2
Diagram of Assessment Parameters
3
Figure 6-1

Community Assessment Parameters
Geography
Population
Environment
Industry
Education
Recreations
Religion
Communication
Transportation
4
Public services
Political organization
Community development or planning
Disaster programs
Health statistics
Social problems
Health manpower
Health professional organizations
Community services
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.

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
6
Windshield Survey
Community vitality
Indicators of social and economic conditions
Health resources
7
Environmental conditions related to health
Social functioning
Attitudes toward health and health care

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
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
9
Steps in the Needs Assessment Process
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
10
Steps in the Needs Assessment Process (Cont.)
Train data collectors
Arrange for a sample representative of the aggregate
Conduct needs assessment
Tabulate and analyze data
Identify needs suggested by data
Develop an action plan
11
Nursing Process
12
The nursing process can be applied to the community as a
client.
Needs assessment
Diagnosing health problems (actual and potential)
Planning

Intervention
Evaluation
Format for Community Health Diagnosis
13
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.
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
14
Discussion Board Forum 5 – Part B
Reply to at least 2 of your classmates' threads, in at least 150
words, building upon the original thread or offering a

contrasting viewpoint. The replies must be substantive, and
must further the discussion.
Please respond at least 150 words to the following:
There are numerous methods of data collection when performing
research. The main type of methods of data collection are
surveys, questionnaires, interviews, focus groups, tests, scales,
and observational methods.
Surveys and questionnaires are are an example of a social
research method that typically focuses on data collection from
and about people (Moser & Korstjens, 2017). Advantages of
surveys and questionnaires are that they provide large amounts
of data standardization, may be adapted to collect generalizable
information from almost any human population and provide a
relatively simple and straightforward appraoach of the study of
attidues, values, beliefs and motives (Robson & McCartan,
2016). Disadvantages of surveys and questionnaires would be
that data is affected by the characteristics of the respondent and
respondents may not necessarily report their beliefs and
attitudes accurately, which can produce social desirability
response bias (Robson & McCartan, 2016). According to
Robson and McCartan (2016), surveys and questionnaires are
typically used in a non-experimental fixed research design.
Interviews and focus groups are another example of social
research that involves a researcher asking questions to another
person (Moser & Korstjens, 2017). Advantages of interviews
and focus groups are it provides a flexible and adatable way of
discovering new information and allow for follow up questions
to be asked to further research concepts and ideas (Robson &
McCartan, 2016). A disadvantage to using interviews and focus
groups would be that interviews and focus groups lack
standardization, which can provide issues with reliability with
the data (Robson & McCartan, 2016). According to Robson and
McCartan (2016), interviews and focus groups are typically
used in qualitative research designs.
According to Robson and McCartan (2016), tests and scales are

typically used in quantitative research designs. Common scales
that can be used for measurement are the summated rating
(Likert) scale, the equal appearing interval (Thurstone) scale,
the cumulated (Guttman) scale and semantic differential scales
(Robson & McCartan, 2016).
According to Robson and McCartan (2016), participant
observation typically utilizes a flexible (qualitative) research
design while a structured observation typically utilizes a fixed
(quantitative) research design. Participant observation is
mostly used for studies focusing on anthropology, sociology,
communication, human geography and social psychology (Pope
& Mays, 202
Top of Form
Bottom of Form
Please respond at least 150 words to the following:
Surveys are a tool used to collect data on a predefined area of
interest. Surveys are generally easy to perform and are often
used under fixed methods, where the contents of the surveys are
planned ahead of time and administered under specific
conditions (Robson & McCartan, 2018). Surveys may be
performed at nearly any time, provided that the respondents are
informed of the approximately time frame that they expect to
complete the survey.
Questionnaires are related to surveys insofar that many surveys
are made up of questionnaires. Questionnaires are asked
questions with a selection of answers. Often these questions are
fixed and fall under fixed designs. As with surveys, they may
be performed at any time provided the subject is informed of the
approximate length of time it will take to complete.
Interviews are formal meetings by which information may be
obtained. Often conducted one-on-one or several on one
different person. These may be tied into questionnaires in that
questions may be prepared ahead of time, be open ended, and be
asked to assess the reaction of the individual being interviewed

(Speer, Christiansen, & Laginess, 2019). Interviews may be
mixed method designs in part due to the questions being
planned in advance, but the respondents' answers allow for
flexibility. Interviews are more logistically difficult to perform
due to potential scheduling conflict with subjects or
administrators. They may be performed at the time when both
schedules may align.
Focus Groups are demographically diverse groups that are
facilitated through guided discussion regarding a topic or
selection of topics. Related to interviews, this is usually
performed with a larger group of people with a moderator
guiding the questions and the discussions. Focus Groups are
characteristic of multiple method designs so that they are
planned but may be flexible due to the diverse nature of a focus
group. Focus groups, involving more people, are more difficult
to perform and thus require a set date and time to administer.
Tests are tools which measure the reliability, validity, quality,
and performance of something. Tests may be administered in
the form of questionnaires or through interviews. Tests are
often characteristic of fixed designs. Tests may be performed in
the same manner as surveys, provided that the subjects receive
adequate information prior to completion of the test as to how
long it will take.
Scales are quantitative assessments, or tests, which provide a
weighted range of options. Often scales are tests which have a
selection of answers on a range rather than any concrete
answers (Vergauwe, Kaiser, Wille, De Fruyt, & Hofmans,
2018). Scales are ideal for mixed method designs due to the
planned nature of the scales but with some amount of flexibility
in the subject responses. Scales are able to be performed at
nearly any time, provided the subjects receive adequate
notification of their time commitment.
Observational Methods are processes by which one observes to
gain information. Direct observation is a method by which the
researcher directly observes the behaviors or actions of the
subjects that they are studying. Indirect observations are

observations that may be filmed or via alternative methods in
observing the subjects. Observations are flexible because in
any area, this method may apply and can be performed at any
time.
Chapter 2
Historical Factors:
Community Health Nursing in Context
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.
2
Aggregate Impact on Health
Increased population
Increased population density

Imbalanced human ecology
Resulted in changes in cultural adaptation
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
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
5

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
6
Disease Definitions
7DiseaseDefinitionsEndemicDiseases that are always present in
a population (e.g., colds and pneumonia).EpidemicDiseases that
are not always present in a population but flare up on occasion
(e.g., diphtheria and measles).PandemicThe existence of disease
in a large proportion of the population—a global epidemic (e.g.,
HIV, AIDS, and annual outbreaks of influenza type A).
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
8
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.
9
Renaissance (15th, 16th, 17th centuries)
A theory about the cause of infection evolved.
Leeuwenhoek described microscopic organisms.
Elizabethan Poor Laws were enacted.
10

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.
11
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.
12
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.
13
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.
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
15
Figure 2-2
Public domain; courtesy University of Chicago Library.
Impact of Important Scientists
Louis Pasteur
Theory of existence of germs
Discovered immunizations in 1881 and the rabies vaccine in
1885
Robert Koch
Discovered causative agent for cholera and the tubercle bacillus
in 1882
Joseph Lister
Surgical success with wound care
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.
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.
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.

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
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

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
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

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
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
25

Chapter 1
Health: A Community View
Nies: Power Points, Evolve Resources for Nies/McEwen:
Community Health Nursing, 4th ed.
1
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.
2
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.
3
http://www.health.gov/phfunctions/public.htm
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
4
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
5
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/HP2020Framew
ork.pdf. Accessed July 2013.
6
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
7
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.
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)
9
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.
10

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.
problems.
11
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.
problems.

12
12
The Three Levels of Prevention
Primary prevention
Prevention of problems before they occur
Health promotion and health protection
Secondary prevention
Early detection and intervention
Early diagnosis and treatment
Tertiary prevention
Correction and prevention of deterioration of a disease state
Limitation of disability and rehabilitation
13
13
The Three Levels of Prevention (Cont.)
14
Figure 1-2

14
Level of Prevention—Individual
15
15
Level of Prevention—Family
16
16
Level of Prevention—Group
17

17
Level of Prevention—Community
18
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.
19

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
community-wide 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
20
20
Healthy People 2020 Topic Areas
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
Disability and Secondary Conditions
Early and Middle Childhood
Educational and Community-based Programs
Environmental Health
Family Planning
Food Safety
Genomics New
Global Health New
21
21
Healthy People 2020 Topic
Areas (Cont.)
Health Communication and 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
HIV
Immunization and Infectious Diseases
Injury and Violence Prevention
Lesbian, Gay, Bisexual, and Transgender
Health New
Maternal, Infant, and Child Health
Medical Product Safety

22
22
Healthy People 2020 Topic Areas (Cont.)
Mental Health and Mental Disorders
Nutrition and Weight Status
Occupational Safety and Health
Older Health New
Oral Health
Physical Activity
Preparedness New
Public Health Infrastructure
Respiratory Disease
Sexually Transmitted Diseases
Sleep Health New
Social Determinants of Health New
Substance Abuse
Tobacco Use
Vision
23
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
24
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
25
*The terms Public Health Nursing and Community Health
Nursing are used interchangeably in Nies and McEwen, 6th
edition.

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
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
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

28
28
PHN Intervention Wheel
29
Figure 1-3
Illustration from Minnesota Dept. of Health Center for Public
Health Nursing.
Is population based
Contains three levels of practice (individual, community, and
system)
Identifies 17 public health interventions
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.
30
30
(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.
31
31
(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.
32
32
(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 self-care 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.
33

33
(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.
34
34
(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.
35
35
Providing population-based care… a shift in thinking
Populations are not homogeneous; must address the needs of
special subpopulations.
High-risk and vulnerable subpopulations must be identified
early in the care delivery cycle.
Nonusers of services often become high-cost users; essential to
develop outreach strategies.
Quality and cost of all health care services are linked together
across the health care continuum.
(Kaiser Family Foundation, 2013)
36

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Chapter 6Community AssessmentCopyright © 2015, 2011, 2007, 2.docx