population focused assessment: subsystems
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Metaparadigm of Nursing
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-consists of the major concepts of discipline- person/community, environment, health, and nursing -Four concepts central to the discipline of nursing comprise the metaparadigm of nursing (overall framework). Guides decision making. -Provides a framework for the community-as-partner model -Viewing the community as a whole entity- Individuals & families
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Community Assessment wheel
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Core, Solid Line, Broken line
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Community Assessment wheel: Core
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represents the people who make up the community (includes demographics of the population as well as their values, beliefs, and history) As residents of the community, people are affected by and influence the eight subsystems of the wheel.
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Community Assessment wheel: Solid Line
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around the community - its Normal Line of Defense (level of health) of the community over time. includes things such as levels of income, low teen pregnancy rates, coping patterns
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Community Assessment wheel: Broken Line
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its Flexible Line of Defense (buffer zone - temporary reaction to stressors)
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Community as Client and Partner
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-Person/ client/patient = The community -Enviroment: conditions circumstances , whats going on their.
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Community
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group of people- share something in common, who interact with one another, may exhibit a commitment to one another (ID name), some type of relationship with each other - interdependent
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Differs from Population
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group who have at least one thing in common, may or may not interact with each other (may or may not have self-awareness)
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Enviroment
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Everything that is internal or external to a given host or agent and that is influenced and influences the host and agent-host interaction. Ex: climate, plant & animal life, population distribution (crowding), socioeconomic factors (education, resources, access to care), working conditions.
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Community as a client
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Health / nursing
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Community as a client: Health
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continuum with wellness at one end and death at the other, absence of disease, state of equlibrium between all subsystems/ communities.
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Community as a client: Nursing
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Prevention. All of nursing in community health is considered in the terms of prevention Primary (reducing encounters between agent & host - sunscreen), secondary (after encounter occurs, early detection to prevent further damage - breast exam), tertiary (maintain and restore to health - rehab). Some interventions can be all three levels, depending on situation, education
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Community assessment
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invloves getting to know the community using a logical, systematic approach to indentifying community needs, clarifying problems, and identifying community strenghts and resources. - a systematic process to; think critically about the community, get to know the community, and understand the community as client
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Collection of Data
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-quantitative / qualitative -Need to collect data for the community assessment. Same as with individual patients using the nursing process....Assessment is first step of the process. -Gather data: Primary (original source - observation, surveys, interviews) and Secondary (taken from published reports - census data, annual reports, health records) -Data is pleural; use data were - not data was
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Collection of Data: quantitative
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Objective Measured in numbers, rates Ex: number of people with heart disease
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Collection of Data: qualitative
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Subjective Measured in words, descriptive Ex: adolescent's opinion on using condoms
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Methods of Primary Data Collection (what you collect)
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1.Survey 2. Interview 3. Meetings 4. Observation
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Methods of Primary Data Collection (what you collect): Survey
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: Method of collecting data through questionnaires. Best used to collect data about demographic information, knowledge, attitudes, and behaviors. Open or closed-ended questions.
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Methods of Primary Data Collection (what you collect): Interveiw
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One on one interaction between the assessor and a community informant. Key informants: Hold positions in the community that provide them with unique insights (public officials, health-care professionals, informal community leaders. -face to face or telephone - Key informant interview:Assumption: A select group of people hold or have access to information needed to comment on a target population. Ex. Homeless shelters- woman and children services
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Methods of Primary Data Collection (what you collect): Meetings
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Community forums, focus groups - Focused groups-Purpose: To obtain the feelings, opinions, view-points, and perceptions of group members regarding a specific topic. -The information obtained from the focus group can help understand public health problems and community strengths. - form of qualitative data collection for needs assessment/program evaluation -Can help design surveys-preliminary -Interpret results of other data collections-Confirmatory -Should have a structured format (with a set of predetermined questions) -Need skilled moderator -Written notes/audio-video recording for review and interpret the results -Small compared to community forum -Recommended size - 8-12 people -Best to have a group of people who don't know one another Participation in the group: usually by invitation
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Methods of Primary Data Collection (what you collect): Observation
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Participant - engaged in the life of the community from within. Outsider - looking at the community from the outside (windshield survey, walking survey) -Ex: checking the smoking behaviors of workers on break, observing eating patterns of school kids in a school lunch room -Advantages: quick cheap safe -Disadvantage: judgmental, not seeing the whole picture , not enough skill, timing of drive by observations
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Additional Sources for Data Collection
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International- Who National- CEC, USDA State- Ohio.gove, odh.gov Local- Health department , TPS
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Why do a Community Assessment?
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Identify community needs, clarify community problems, and identify community strengths and resources. Comparison- our community versus another community of our size. Also compare with state and national data -what resouces are utalized - identify potential groups / problems -risk factors or illness -maximize resources -for program planning
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Community Assessment Questions
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REligion, How do you descrbe yourself, family sizes, demographics, economic dwellings , employment, poverty, access to insurance , transportation, perceive as health problems, childcare whats available
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Community As Partner Tool: Systems model
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with the focus on primary health care as defined by World Health Organization to use a total person approach to assess community problems. Major components: Community Assessment Wheel and the Nursing process - Paper Includes theory of stress adaptation - Neuman
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Assess the Various Subsystems within the Community
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Go from broad to focused. Nationally - all ages Bottom of pyramid Local- county, city, or neighborhood Age specific- (older adults) Selected Health issue- top of pyramid
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Types of Community Assessments
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Community Assets Assessment Community Subsystem Assessment Comprehensive Assessment Needs Assessment Problem-oriented Assessment Windshield Survey
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Types of Community Assessments: Assets
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looking at community strengths
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Types of Community Assessments: Community subsystems
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each person in a public health department takes a few subsystems to evaluate the whole community - -subsystems: Core and vital statistic, physical enviroment, health and social services, economy,transportation and safety,Politics and government, communication, education, recreation, perceptions
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Types of Community Assessments: Comprehensive
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all relevant community health information, key informant interviews, surveys- expensive, time consuming process- seldom performed
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Types of Community Assessments: Needs
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Step 1. PERFORM A \"GAP\" ANALYSIS Step 2. IDENTIFY PRIORITIES AND IMPORTANCE Step 3. IDENTIFY CAUSES OF PERFORMANCE PROBLEMS AND/OR OPPORTUNITIES. Step 4. IDENTIFY POSSIBLE SOLUTIONS AND GROWTH OPPORTUNITIES.
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Types of Community Assessments: Problem-Oriented
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single problem & assesses the community in terms of that problem
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Types of Community Assessments: Windshield
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drive or walk- used when RN works with families, groups, organizations, and populations
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Types of Community Assessments: Community subsystems:Core and vital statistics
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Lourdes College Assessment - broad (Sylvania) more focused (LC) Community Core Demographics (age, race, SES) - students, faculty, staff, Sisters of St. Francis History (Mother Adelaide, Franciscan order, how Sylvania got it's name) Values and Beliefs (religion, churches, temples, historical markers, well cared for neighborhoods or run down) Culture (indicators of ethnic groups - restaurants, grocery stores, language) Vital Statistics Enrollment data, graduation rates, number of grievances filed, types of programs and degrees offered -Who are these people? What is their history? What are their values? What is its culture? What are leading causes of morbidity and mortality?
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Types of Community Assessments: Community subsystems: Physical Enviroment
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Define boundaries of community of interest - map, divided by lake, river, etc. Lourdes College - -How does the community look? Air quality? Flora, housing, zoning, space, green areas, animals, people, Natural beauty, human made structures, and climate? What is the size of the community?
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Types of Community Assessments: Community subsystems: Health and Social Services
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Traditional healers? Clinics, hospitals? Public health services? Home health? Nursing homes? Social services for acute and chronic conditions? Resources outside the community but accessible? -rdes College - Closest hospital - Flower TRIO program Counseling Services - Kathy Dailey Accessibility Services Rosary Care Center BEAT Program Diversity & Multicultural Services WIN Center Advising Center
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Types of Community Assessments: Community subsystems: Economy
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Thriving or poor? (% at/below poverty level) Types of occupations Industries Stores/shopping Unemployment rate -urdes College - Financial Aid Office Bursar Office Bookstore Café Lourdes Career Services - Janet Dickson
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Types of Community Assessments: Community subsystems: Transportation and Saftey
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How do people get around? Private & public means? Buses, bicycles, taxis, sidewalks, bike trails? Protective services including fire, rescue, police, sanitation. Types of crimes and do people feel safe?
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Types of Community Assessments: Community subsystems:Politics and Government
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Predominant party affiliations? Government jurisdictions? Are the people involved in decision-making? What types of legislation, standards or rules are in place? -Lourdes College- Governed by BOT, President, Vice-Presidents, college organizational chart VPAA - Academic issues, VPSS - Non-academic issues Student Government Association Student Organizations
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Types of Community Assessments: Community subsystems: Communication
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Common gathering places? Newspapers, TVs, radios What do people watch & listen to? What are the formal and informal means of communication? -Lourdes College Ebeid Center, where else? Tau Literary Magazine, Carrilon, Weekly Howl Lourdes portal, email, Student handbook - means of communication, Lourdes world - blogs, announcements, formal vs informal?
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Types of Community Assessments: Community subsystems: Education
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Schools and colleges? Libraries? What is the reputation of the schools? Drop-out rates? Extracurricular activities? School health services? Mean level of education? -Lourdes College WIN Center Library Graduation rates, entering GPA, Undergrad & Graduate students - Research Symposium April Education of faculty & staff
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Types of Community Assessments: Community subsystems: recreation
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Where do residents play? Major forms of recreation? Facilities and Resources? What is available for selected population? -Lourdes College- Formal & informal sports programs - Intramural basketball Gym, exercise area, is it adequate for population of college? Student sponsored events through student life association; passport program Planetarium, Life Lab, Theater Vision, Franciscan Center Recreation for faculty & staff; pilates, yoga classes, Zumba - Lisa Binkowski
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Types of Community Assessments: Community subsystems: Perceptions
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Community Members How the people feel about their community? What do they see as the strengths and weaknesses? Assessors How do you perceive the community? What problems or potential problems exist? -Lourdes College - Your perceptions about the college Outsiders perceptions about the college Do all groups feel equally welcome?
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Community Analysis what is a \"Healthy community?\"
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High degree of awareness that \"we are a community\" Uses natural resources wisely Recognizes the existence of subgroups & is welcoming Is prepared to meet crises Is a problem-solving community -back to Nursing Process Assessment Next is Analysis - in order to form a community diagnosis
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Phases of Community Analysis
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1.Categorize or cluster data 2.Summarize 3.Compare Use benchmarks to interpret data County, state, national comparisons Local, state & national health goals 4. Draw inferences
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Phases of Community Analysis: Catorgorize or cluster data
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according to: demographics, geographical characteristics, socioeconomic characteristics, health resources & services Models such as the community assessment wheel are utilized because they provide a framework for analysis
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Phases of Community Analysis: Summarize
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data in each subsystem category- use rates, charts, & graphs
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Phases of Community Analysis: Compare
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community data to other similar data. Community's IMR of 12 per 1,000 live births- how does this compare with the city? State? Nation? For Lourdes College; our graduation rate compared to similar institutions in Ohio and nation Also, compare across time to detect trends (Healthy People 2010 provides national incidence & prevalence data)
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Phases of Community Analysis: Draw inferences
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the inferences you draw will assist you with deriving a nursing diagnosis for your community
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Community Analysis
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Develop community problem list Develop community capabilities list Expand analysis to include problem (causes) Prioritize concerns - Always do this -you want to callect by most amt of people with least amt of money spent
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Probelm Identification Measuring the Need for Service
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Health Status Problem: The gap between what is and what should be Challenge: Defining what is and what should be Extent: What is the incidence or prevalence? Duration: How long has this condition existed? Future: What is the likely course with/without intervention? Variation: Does the problem vary across populations/geography?
