Planning_and_Developing_Community_Programs_and_Services_copy[2426][1] [Read-Only].pptx

Planning and Developing Community Progra
ms and Services
King Saud
University
Student Name:
Wafa Zahrani

-any planned or unplanned alteration of the status quo in an
organism, situation, or process.
-From a systems perspective, change means that things are out of
balance or the system’s equilibrium is upset .
-change occurs when the innovation is accepted, tried, and integra
ted into daily practice.
-change requires adjustment in thinking and behavior, and people
’s responses to change vary according to their perceptions of it.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5
Change is:

-The change process can be described :
-Evolutionary change:
-change that is gradual and requires adjustment on an incremental
basis. It modifies rather than replaces a current way of operating
-Revolutionary change:
- is a more rapid, drastic, and threatening type of change that may
completely upset the balance of a system, It involves different
goals and perhaps radically new patterns of behavior.

Stages of Change:
The phrase stages of change refers to the three sequential steps
leading to change:
1. Unfreezing (when desire for change develops)
2. Changing (when new ideas are accepted and tried out)
3. Refreezing (when the change is integrated and stabilized in pr
actice)

1-unfreezing:
occurs when a developing need for change causes disequilibrium
in the system. A system in disequilibrium is more vulnerable to c
hange.
2-Changing/Moving:
The second stage of the change process, changing or moving,
occurs when people examine, accept, and try the innovation .
3-Refreezing:
occurs when change is established as an accepted and permanent
part of the system

five categories of adopters:
1. innovators who are usually the first to try something new.
2. early adopters who are often opinion leaders that have some
awareness of a need for change
3. early majority who are usually followers (not leaders) who
want to examine the evidence before trying out a new
behavior.
4. late majority who often are suspicious of change and only
adopt a behavior after the majority of the population have
done
5. laggards who are very traditional, skeptical, and conservative
and represent the most difficult group to convince.

Planned/Managed Change
 Leaders in community health nursing have been change agents
for decades. They have planned and managed change in
a variety of systems. Planned change is a purposeful, designed
effort to effect improvement in a system with the assistance of
a change agent per Spradley’s classic definition

-Characteristics of planned change:
1. The change is purposeful and intentional: There are specific reasons or g
oals prompting the change
2. The change is by design, not by default: Thorough, systematic planning pr
ovides structure for the change process and a map to follow toward a plan
ned destination
3. Planned change in community health aims at improvement. That is, it seek
s to better the current situation, to promote a higher level of efficiency,
safety, or health enhancement. Planned change aims to facilitate growth
and positive improvements.
4. Planned change is accomplished through an influencing agent: The change
agent is a catalyst in developing and carrying out the design; the change a
gent’s role is a leadership role.

Planned-Change Process:
- eight basic steps leads to the management of change:
1. recognize symptoms
2. diagnose need
3. analyze alternative solutions,
4. select a change,
5. plan the change,
6. implement the change,
7. evaluate the change,
8. stabilize the change

Step 1: Recognize (Assess) Symptoms:
This step requires gathering and examining the presenting
evidence, not diagnosing or jumping ahead to treatment.
Step 2: Diagnose Need :
Diagnosis involves analyzing the symptoms and reaching
a conclusion about what needs changing.

Step 3: Analyze Alternative Solutions:
it is time to identify solutions or alternative directions to follow.
Brainstorming and Reviewing the literatureis helpful here,
and the client system should be involved as much as possible in
the process.
Step 4: Select a Change:
After all alternatives have been carefully analyzed, the best
solution must be selected.

Step 5: Plan the Change:
that guides the change action, The plan tells the change agent and
the clients how to meet that goal. Preferably.
Step 6: Implement the Change :
enacting the change plan.

Step 7: Evaluate the Change:
evaluation does not end with saying whether the objectives were
met. Each objective requires analysis: Was it met? What evidence
(documentation) shows that it was met? Was it accomplished usin
g the best means possible, or would another method have been
better?
Step8: Stabilize the Change:
The final step in the planned-change process requires taking
measures to reinforce and maintain the change. A well-developed
change plan includes a design for stabilization.

Planned-Change Strategies:
1-Empiric–Rational Change Strategies :
Empiric–rational change strategies are used to effect change
based on the assumption that people are rational and, when
presented with empiric information, will adopt new practices that
appear to be in their best interest

2-Normative–Reeducative Change Strategies:
Used to influence change that not only presents new information
but also directly influences people’s attitudes and behaviors throu
gh persuasion. It is a sociocultural reeducation
3-Power–Coercive Change Strategies:
Power–coercive change strategies use coercion based on fear to e
ffect change

Principles for Effecting Positive
Change:
1) Principle of participation.
2) Principle of resistance to change,
3) Principle of proper timing.
4) Principle of interdependence.
5) Principle of flexibility.
6) Principle of self-understanding.

SOCIAL DETERMINANTS OF HE
ALTH
 Social determinants of health are “conditions in t
he environments in which people are born, live, l
earn, work, play, worship, and age that affect a
wide range of health, functioning, and quality-of-l
ife outcomes and risks”
 such as access to social and economic opportun
ities; safe housing; quality education; clean wate
r, food, and air; safe workplaces; equitable social
interactions (class, race, and gender); and adeq
uate community resources.

Community action model—creating change by
building community capacity.

CHANGE THROUGH HEALTH EDUCATIO
N
 For the community health nurse, health education is a f
oundation of practice.

 Knowledge of educational theories and teaching method
s can assist the nurse to frame these “health messages”
for the greatest impact and chance of success.

 Teaching is a specialized communication process in whic
h desired behavior changes are achieved and the purpos
e of teaching is to change client behavior to healthier pra
ctices. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23

DOMAINS OF LEARNING
 Learning occurs in three domains: cognitive, affective, and psychomotor
.
 The cognitive domain of learning involves the mind and thinking processes.
 There are six major levels in the cognitive domain :
 knowledge, comprehension, application, analysis, synthesis, and evaluation
.
 The affective domain involves learning that occurs through emotion, feeling,
or affect. This kind of learning deals with changes in interest, attitudes, and
values.
 Affective learning occurs on several levels :
 Receptive, responding, valuing, Internal consistency, adoption
 Psychomotor learning involves the acquisition of motor skills. Clients who le
arn psychomotor skills must meet three conditions: they must be capable of
the skill, they must develop a sensory image of the skill, and they must pract
ice the skill. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24

LEARNING THEORIES
 (1) behaviorist theories, which view learning as a behavioral change accom
plished through stimulus–response or conditioning
 (2) cognitive learning theories, which seek to influence learners’ understandi
ng of problems and situations through promoting their insights
 (3) social learning theories, which explain dysfunctional behavior and facilita
te learning
 (4) humanistic theories, which assume that people have a natural tendency
to learn and that learning flourishes in an encouraging environment.
 (5) Knowles’ adult learning theory provides a framework for understanding a
dult characteristics and appropriate teaching interventions.

Characteristics of effective
instructors or health educators
•
Organization and ability to make things clear
•
Positive, enthusiastic attitude
•
Good communicators

Characteristics of effective health
education curriculum
•
Functional knowledge
•
Develop essential health skills
•
Shapes personal values
•
Shapes norms
•

Health teaching models

Health belief model
•
The HBM is useful for explaining the behaviors and actions taken by
people to prevent illness and injury.
•
It suggests that readiness to act on behalf of a person’s own health is
based on the following;

Perceived susceptibility to the condition in question

Perceived seriousness of the condition in question

Perceived benefits to taking action

Barriers to taking action

Cues to action, such as knowledge that someone else has the condition
or attention from the media

Self-efficacy the ability to take action to achieve the desired outcome

Pender’s health promotion model
•
Was intended as a framework for exploring health-
related behaviors within a nursing and behavioral
science context
•
It includes three general areas of concern to health-
promoting behaviors;

Individual characteristics and experiences

Behavior-specific cognitions and affect

Behavioral outcomes

Transtheoretical or stages of
change model
•
Behavioral change doesn’t suddenly happen after action
during a health education class but rather occurs in small
growths or stages.
•
The stages include the following;

Precontemplation

Contemplation

Preparation

Action

Maintenance

termination

Precede and proceed , models
•
The acronym PRECEDE has been slightly revised from the original
to stand for Predisposing, Reinforcing, and Enabling Constructs in
Educationecological, Diagnosis, and Evaluation.
•
The acronym PROCEED stands for Policy, Regulatory, and
Organizational Constructs for Educational and Environmental
Development
•
Together include eight phases:

Social

Epidemiologic

Educationecological assessments

Administrative and policy assessment and intervention alignment

implementation

The PROCEED model is emphasized in the last
three phases;

Process evaluation

Impact evaluation

Outcome evaluation

Teaching at three levels of
prevention
•
The teaching program should be established within the
level of prevention needed by the client
•
The levels of the prevention pyramid

Primary

Secondary

Tertiary

Effective teaching
•
Teaching is an art
•
Rather than relying on prescribed teaching methods, the
skillful community health nurse can make judgments
based on the client’s qualities, situations, and needs that
guide the experience.

Teaching-learning principles
•
Teaching lies at one end of the continuum at the other end is learning
•
Factors that influence clients’ lifestyle-related health behaviors;

Attitudes

Beliefs

Motivation

Volition

Planning

Social support

Self-monitoring

Social and material environment

‫تهاني‬

PROGRAM PLANNING: THE BASICS
• • Public health education programs are defined as interventions “design
ed to inform, elicit, facilitate, and maintain positive health practices in
large numbers of people.”
• Public health education programs inform and encourage large popula
tions to adopt positive health practices.
• Nurses play a vital role in planning, implementing, and evaluating these pro
grams.
• They use a variety of strategies, ensure cultural and age appropriatenes
s, and include evaluation components. (ANAStandard 5B)

IDENTIFYING GROUP OR COMM
UNITY HEALTH PROBLEMS
Nursing education focuses on individuals, families, and communities, but nurses often practice
at the individual and family level.
• Nurses can expand their practice to the community level to address persistent health
issues.
• They can identify these issues by considering objectives like Healthy People
2020
,
etats
,seitiroirp
dna
lacol
slaog
.
• Nurses collaborate with community agencies to find solutions for individuals and
families facing problems.
• Examples of community health issues include ER overuse, elderly hospitalizations,
child car seat safety, and improving outcomes for diabetes and asthma, and addressing
childhood obesity.

Delineating the Problem to be
Addressed
•- Nurses identified childhood obesity as a problem in a local elementary
school.
•- Initial plan for a special educational program was deemed embarrassing
and ineffective.
•-Advisory group identified behavioral factors contributing to childhood
obesity.
•- Factors include unhealthy school lunches, lack of physical activity, and
stress.
•- Nurses are developing a health promotion program to address these
factors.

Rating the Importance and Changeability of Identified
Behavioral Factors
1. - Focusing on a limited number of health behaviors is crucial for program
success.
2. - Prioritization should be based on importance and changeability.
3. - Importance is determined by frequency and link to health problems.
4. -Availability of sports equipment ranked lower in importance for
childhood obesity.
5. - Poor quality of school-provided meals was highly rated as a
contributing factor to obesity.

Importance of Behaviors Contributing to Childhood Obesity
at Stevens Place Elementary School

Changeability Ratings of Behaviors Contributi
ng to Childhood Obesity at Stevens Place Elem
entary School
Changeability Ratings of Behaviors Contributing to

Rankings of Behaviors Contributing to Childhood
Obesity at Stevens Place Elementary School by
Importance and Changeability

•The PRECEDE-PROCEED model is a framework for planning and evaluating health
promotion
programs.
•The model identifies three categories of factors that affect individual behavior:
predisposing factors, reinforcing factors, and enabling factors.
•Predisposing factors are the beliefs, attitudes, and knowledge that influence a person's
behavior.
•Reinforcing factors are the things that encourage a person to continue a behavior.
•Enabling factors are the resources and opportunities that make it possible for a person to
change their behavior.
Factors That Influence Behavior Change:
Predisposing, Reinforcing, and Enabling
Factors

Predisposing, Enabling, and Reinforcing Factors That Influence Meal
Choices of Fifth and Sixth Grade Students Attending Stevens Place
Elementary School

EVALUATION OF OUTCOMES
•The Public HealthAccreditation Board has 12 domains of standards, three of which are particularly
relevant to program development and outcome measurement:
• Engage with the community to identify and address health problems
• Evaluate and continually improve health department processes, programs, and interventions
• Contribute to and apply the evidence base of public health
•Logic models are a tool that can be used to plan and evaluate health promotion programs.
•Logic models show the causal relationship between the inputs, activities, outputs, and outcomes of a
program.

CASE STUDY ON LOGIC MODELS FOR PROGRAM PLANNING, MONIT
ORING AND EVALUATION

Setting Measurable Goals and Objectives
 Using the logic model as a guide, planned programs should
have specific goals to help identify who the program is sup
posed to serve, what services are provided, the length of ti
me the services are to be provided, and the resources that a
re needed.
 Then, measurable objectives are developed that describe th
e expected outcomes.
52

Evaluation of Outcomes
53
• Ensure quality through measurable outcomes and standards of practice in
programs and services
– Setting measurable goals and objectives
– Evaluating outcomes
• Quality indicators of client outcomes: quantitative measures of client’s response
to care; part of a broader quality management program; used to determine goal
achievement
• Benchmarking: continuous, collaborative, systematic processes for measuring
and examining internal programs’ strengths and weaknesses; also studying
another’s processes to improve own

54
Nurse’s Role in Quality
Measurement and Improvement
• Any activities to realize goals contribute to the quality
management program
• Nursing administration responsible for developing a formalized
quality management program
– Review organizational structure, personnel, and environment
(structure)
– Focus on standards of nursing care and methods of delivery
(process)
– Focus on outcomes of that care

Nurse’s Role and Structure
55
• Client focus
• Sufficient resources
• Budgeting and system for acquiring additional
funding
• Private agencies and profit

Nurse’s Role and Process
56
• Standards set by professional staff complying with or surpassing
those recommended by accrediting bodies
• Staff input in standard evaluation, revision
• Staff current in practice
• Agency support of staff; minimal staff turnover
• Staff as part of peer review committee or quality improvement or
assurance committee
• Staff involvement with clients for suggestions and comments;
agency acting on suggestions and comments

Nurse’s Role and Outcomes
57
• Periodic review of standards and ability to meet needs of
population
• Staff implementation of standards
• Nursing services used most frequently

Models Used in Program Eva
luation
58
• Donabedian Model
• Quality Health Outcomes Model
• American Nurses Association Model
• Omaha System
• Quality Practice Setting Attributes Model

63
• Influence on the behavior of target audiences through changes in:
– Behavior
– Policies that affect health behaviors
– Perceptions and support for public health as an institution
Social Marketing

Social Marketing
64
• Key concepts
– Exchange
– Self-interest
– Behavior change
– Competition
– Consumer orientation
– Product, price, place, and promotion
– Partners and policy

Grants
65
• Individual or group providing another individual or group with
support (money) for a specified purpose
• Funding for program development or project support
– Planning grants
– Start-up grants
– Management or technical assistance grants
– Facilities or equipment grants

Grants (cont.)
66
• Sources: government, private philanthropic, corporate
• Letter of inquiry possibly before application/proposal
• Grants highly competitive

References
Rector, C. L. (2018, January 1). Community and Public Health Nursing
. LWW.
67

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