Chapter 7Community Health Planning, Implementation, and

Chapter 7
Community Health Planning,
Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
The Community as Client
an imprint of Elsevier Inc. 2
Figure 7-1
Levels of
Community Health Nursing Practice
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
Figure 7-2
Hogue (1985)
Steps in the Health Planning
Model
expectations
ith the “norm”

effective plan
Four Types of Needs to Assess
population
professionals
and desires expressed by audience
disadvantaged population

Factors for Determining Priorities
problem
and available resources
y use Maslow’s hierarchy of needs or
levels of prevention to further refine priorities
Community Involvement Is Essential
“Start where the people are!”
e spheres of empowerment

– Labonte (1994)
Steps in the Health Planning Model
(Cont.)
• Subsystem, aggregate system, and/or suprasystem
• Primary, secondary, or tertiary levels of prevention
interventions according to available resources
• Personal, aggregate, and suprasystem

Development of Goals and
Objectives
—where we want to be
—steps needed to get there
(Cont.)
the clients

a variety of strategies
Interventions by
Type of Aggregate and System Level
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

(Cont.)
and the
nurse’s detailed analysis
strengths and weaknesses
(product/outcome) aspects
-up recommendations
Importance of Each Step in the
Nursing Process
health and demographic profile

presented in the literature
goals that the nurse and the aggregate accept.
entions must include aggregate participation
and must meet the mutual goals.
evaluation and aggregate input.
PRECEDE-PROCEED Model
Federal Legislation Affecting Health
Planning
-Burton Act

)
Development Act
Comprehensive Health Reform
Act
(2010)
-based
recommendations
and population health
care

Nurses’ Role
improve aggregate health
care needs and skills
process
-level projects
Chapter 6
Community Assessment

Defining the Community
pace and time
influenced by the passage of time
functions
Diagram of Assessment Parameters

Figure 6-1
Community Assessment Parameters
anization
or planning

organizations
Healthy Communities
community members bring
about positive health
changes
people and the public and
private sectors is essential to
make changes.
unique perspective.

Assessing the Community
through “sight, sense, and sound”
e and
their role in the community
Windshield Survey
and economic
conditions

conditions related
to health
health and health
care
Assessing the Community (Cont.)
us data and other census reports
descriptive information about the population

Assessing the Community (Cont.)
focus groups, or surveys
Steps in the Needs Assessment
Process
1. Identify aggregate for assessment
2. Engage the community in planning the assessment
3. Identify required information
4. Select method of data gathering
5. Develop questionnaires or interview questions
6. Develop procedures for data collection

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
Nursing Process
● The nursing process can be applied to the
community as a client.

problems (actual and
potential)
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.
Epidemiological Studies Used
Throughout the Nursing Process

effectiveness of certain interventions in
specific aggregates
of program objectives
of successful programs
data
Chapter 4
Health Promotion and Risk Reduction
.Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
Health Promotion Is…

related organizational, economic, and
environmental supports for behavior of
individuals, groups, or communities
conducive to health (Green & Kreuter, 1991)
increase well-being and to reach the best
possible health potential (Parse, 1990)
Health Protection Is …(Cont.)
with the specific intent to prevent disease,
detect disease in the early stages, or
maximize health within the constraints of
disease (Parse, 1990)
aintaining health

Defining Health
focus on the curative model, to a focus on
multidimensional aspects such as the social,
cultural, and environmental facets of life and
health (Benson, 1996)
goal, but as a resource for living (WHO, 1986)
Healthy People 2020 …
nation.
professionals … to take specific steps to
ensure that good health, as well as long life,

are enjoyed by all.
– U.S. Department of Health and
Human Services, 2012
Healthy People 2020 …
(Cont.)
-quality, longer lives free of preventable
disease, disability, injury, and premature death.
improve the health of all groups.
promote good health for all.
velopment, and
healthy behaviors across all life stages.

Determinants of Health
s and
interventions
-quality
health care
Figure 4-1
From U.S. Department of Health
and Human Services.
Theories in Health Promotion

Risk and Health
will occur in a given time frame” (Oleckno,
2002).
with a disease (Friis & Sellers, 2004).
Risk Assessment is a systematic way of
distinguishing the risks posed by potentially
harmful exposures.

Steps in Risk Assessment
zard identification
Risk Assessment
king, lifestyle,
eating habits, activities
age, environmental exposure

actual or potential threats to their
health
public regarding threats
ons,
process, and actions
Tobacco and Health Risk
and those living below poverty level

Health Promotion Activities
Alcohol Consumption and Health
festyle-related
cause of death for the nation
-term use causes acute
risks

-term effects have major
impact on health and social
issues
U.S. youth
Health Promotion Activities (Cont.)
abuse and dependence
alcohol
-wide effort to address
the problem on several fronts

Diet and Health
—one of most modifiable risk
factors
physical activity
metabolism, genetics, behavior,
environment, culture, and
socioeconomic status
influence weight
needs

http://myplate.gov/
Physical Activity and Health
health promotion and
disease prevention
purposes
influenced by level of

education, gender, age,
economic level, geography
significant role in activity
level
“walkable” neighborhoods and
cities
exercise levels for individuals
http://www.cdc.gov/physicalacti
vity/data/facts.html

Sleep and Health
chronic disease prevention and
health promotion
life circumstances
ed by waking time and
circadian rhythms
memory, blood pressure, and kidney
function.

daily activities
promotes sleep
interfere with sleep
Chapter 3
Thinking Upstream: Nursing Theories and
Population-Focused Nursing Practice
Health Care Today
Are we too busy
rescuing victims …
© Penny Leake

Health Care Today (Cont.)
…to look upstream
where the real
problems lie?
– McKinlay, 1979© Penny Leake
Microscopic Approach to Solving
Community Health Problems
family, response to health and
illness
responses to individual’s illness
or lifestyle patterns
ions are often
aimed at modifying individual’s
behavior by changing his or her
perceptions or belief system

Macroscopic Approach to Solving
Community Health Problems
themes in health and illness
perpetuate the development of illness or foster
the development of health
environmental precursors of illness
social or environmental variables
Theoretical Approaches
(Microscopic)
-care deficit theory of nursing
change (Macroscopic)
retical perspective

Variables and Relationships
in the Health Belief Model
Figure 3-1
Presenter
Presentation Notes
Redrawn from Rosenstock IM: Historical origins of the health
belief model. In Becker MH, editor: The health belief model and
personal health behavior, Thorofare, NJ, 1974, Charles B Slack
Critical Interactionism
Nurses can use both an upstream and a
downstream approach to address health issues
through critical interactionism.
Critical Interactionism (Cont.)

Issue Downstream Upstream
Approach
Critical
Interactionism
Clients:
Obesity rates
Individual
behavior
strategies to
reduce weight.
Lifestyle changes
Bariatric surgery
nursing care.
Health policy
changes.
Vending
machines in
school with
healthier choices.
School lunch
program
modifications.
Target
corporations that
profit from obesity.

Individual
strategies with
weight loss in
conjunction with
system changes.
Social marketing
at both levels.
Approach
Critical
Interactionism
Client or Nurse:
Workplace
violence.
Behavior change
at individual level.
Workplace
programs to
reduce violence.
Address
organizational
factors that

promote
workplace
violence.
What
organizational
structures
perpetuate
workplace
violence?
Change needed in
knowledge and
skills to address
issue of
workplace
violence at both
the downstream
and upstream
level.
Approach
Critical
Interactionism
Nurse:
Workplace errors

Focus on
individual: root
cause analysis
that has individual
as focus.
Change behavior
of individual
nurse.
Reeducation of
nurse with
workplace error.
System changes
needed.
What system level
factors lead to
workplace errors?
What
organizational
structures
perpetuate
workplace errors?
A dual approach.
Providers need
changes in
knowledge and
skills to address
root causes of
workplace errors
that move from

individual to
system level.
By thinking about the root causes of health
problems, we begin to understand the
importance of directing nursing efforts toward
the antecedents of poor health and lost
opportunities.
The Social Determinants of Health topic area
within Healthy People 2020 is designed to
identify ways to create social and physical
environments that promote good health.
Nursing with the Community
Bellack (1998)
community; it is not imposed by others.
multiple viewpoints are the norm.
g patient

Chapter 3Health Care TodayHealth Care Today
(Cont.)Microscopic Approach to Solving Community Health
ProblemsMacroscopic Approach to Solving Community Health
ProblemsTheoretical ApproachesVariables and Relationships
�in the Health Belief ModelCritical InteractionismCritical
Interactionism (Cont.)Critical Interactionism (Cont.)Critical
Interactionism (Cont.)Slide Number 12Nursing with the
Community�Bellack (1998)
RUBRIC: DISCUSSION BOARD (30 pts)
Last updated: 1/31/2020 © 2020 School of Nursing - Ohio
University Page 1 of 1
NOTE: No direct quotes are allowed in the discussion board
posts.
*Peer-reviewed references include professional journals (i.e.
Nursing Education Perspectives, Journal of Professional
Nursing, etc. – see library tab on how to access these from
database searches), professional organizations (NLN, CDC,
AACN, ADA, etc.) applicable to population and practice area,
along with clinical practice guidelines (ECRI Institute -
https://guidelines.ecri.org). All references must be no older than
five years (unless making a specific point using a seminal piece
of information) References not acceptable (not
inclusive) are UpToDate, Epocrates, Medscape, WebMD,
hospital organizations, insurance recommendations, &
secondary clinical databases.
**Since it is difficult to edit the APA reference in the

Blackboard discussion area, you can copy and paste APA
references from your Word document to the Blackboard
discussion area
and points will not be deducted because of format changes in
spacing.
Criteria
Levels of Achievement
Meets Expectations Needs Improvement Unsatisfactory
Characteristics
of initial post
10 to 10 Points
• Provided response with rationale.
• The post is substantive and reflects careful
consideration of the literature.
• Examples from the student’s practice/experience are
provided to illustrate the discussion concepts.
• Addressed all required elements of the discussion
prompt.
• Well organized and easy to read.
3 to 9 Points
• Provided response missing either
substantive rationale, consideration of the
literature, or examples from the student’s
practice/experience to illustrate the
discussion concepts.

• Addresses all or most of required elements.
• Somewhat organized, but may be difficult to
follow.
0 to 2 Points
• Provided response with minimal
rationale.
• Does not demonstrate thought
and provides no supporting
details or examples.
• Provides a general summary of
required elements.
Support for
initial post
5 to 5 Points
• Cited minimum of two references: at least one (1)
from required course materials to support rationale
AND one (1) from peer-reviewed* references from
supplemental materials or independent study on the
topic to support responses.
• The initial post is a minimum of 200 words excluding
references.
2 to 4 Points
• Missing one (1) required course reference
AND/OR one (1) peer-reviewed reference to
validate response.

• Post has at least 200 words.
0 to 1 Points
• Missing 1 or more of the correct
type (course or peer-reviewed)
or number of references to
support response.
• Post is less than 200 words or
there’s no post.
Responses to
Peers
10 to 10 Points
• Responses to colleagues demonstrated insight and
critical review of the colleagues’ posts and stimulate
further discussion
• Responded to a minimum of two (2) peers and
included a minimum of one (1) peer-reviewed* or
course materials reference per response.
• Responses are a minimum of 100 words and are
posted on different days of the discussion period by
the due date.
4 to 9 Points
• Responses to colleagues are cursory, do not
stimulate further discussion and paragraph
could have been more substantial.

• Responses missing one of the following:
o insight/critical review of colleague’s
post,
o OR respond to at least two peers,
o OR a peer reviewed*or course materials
reference per response
• Responses are a minimum or less than
100 words and posts were on the same
date as initial post.
0 to 3 Points
• Responses to colleagues lack
critical, in depth thought and
do not add value to the
discussion.
• Responses are missing two or
more of the following:
o insight/critical review of
colleagues’ post
o AND/OR response to at least
two peers
o AND/OR a peer reviewed*
reference per response.
• Responses are less than 100
words, posted same day as
initial post.

APA format*;
Spelling/
Grammar/
Punctuation
5 to 5 Points
• APA format** is used for in-text citations and
reference list.
• Posts contain grammatically correct sentences
without any spelling errors.
2 to 4 Points
• APA format is missing either in-text or at
end of the reference list.
• Posts contain some grammatically correct
sentences with few spelling errors.
0 to 1 Points
• Not APA formatted OR APA
format of references has errors
both in-text and at end of
reference list.
• Post is grammatically incorrect.
https://guidelines.ecri.org/

Chapter 7Community Health Planning, Implementation, and

Chapter 7Community Health Planning, Implementation, and

Recommended

Recommended

More Related Content

Similar to Chapter 7Community Health Planning, Implementation, and

Similar to Chapter 7Community Health Planning, Implementation, and (20)

More from JinElias52

More from JinElias52 (20)

Recently uploaded

Recently uploaded (20)

Chapter 7Community Health Planning, Implementation, and