The Community as Client: Assessment and Diagnosis

1
The Community as Client Assessment and Diagnosis

• Allender and Spradley - Chapter 18

2
Why Nurses Work with Communities

• The community as client refers to the concept of
  a community-wide group of people as the focus of
  nursing service
• The community directly influences the health of
  its constituents
• Provision of most health services, like the
  development of specific health programs and
  dissemination of health information, occurs at
  the community level

3
Values and Myths

• In the US, individualism is a core value that
  gives meaning to life and provides motivation for
  people
• It is a myth that community health nursing is
  defined by its setting or location (location
  myth)
• It is a myth that community health nurses employ
  only the skills of basic clinical nursing when
  working with community clients (skills myth)
• It is a myth that the primary community health
  clients are individuals and families (client
  myth)

4
Three Dimensions of Community

• Location variables include community boundaries,
  location of health services, geographic features,
  climate, flora and fauna, and the human-made
  environment
• Population variables include size, density,
  composition, rate of growth or decline, cultural
  characteristics, social class, and mobility of
  all the diverse people living within the
  boundaries
• Social system variables include the health
  system, family systems, economic system,
  educational system, religious system, welfare
  system, political system, recreational system,
  legal system, and communication system

5
Factors in Community Dynamics

• Citizen participation - ranges from apathy to
  widespread and may be uninformed or obstructive,
  with the goal being self-care
• Power and decision-making structure - may reside
  in the political system or unevenly among
  organizational leaders
• Collaboration efforts - refers to the ability of
  the community to work together as a team of
  citizens, professional and lay people to meet
  needs

6
Needs Assessments

• Community needs assessment is the process of
  determining the real or perceived needs of a
  defined community of people
• Activities overlap and are repeated constantly
  throughout the assessment
• 1. collection of pertinent data, including
  lifestyle behaviors
• 2. analysis and interpretation of data,
  including morbidity and mortality data

7
Types of Needs Assessments

• Familiarization - studies available data, perhaps
  adding some firsthand data, to gain a general
  understanding of the community (windshield
  survey)
• Problem-oriented - focuses on a single problem
  and studies the community in terms of that
  problem
• Community subsystem - examines a single dimension
  of community life
• Comprehensive - surveys the entire community in
  depth
• Assets - focuses on the strengths and capacities
  of a community to change

8
Assessment Methods

• Survey - a series of questions, used to collect
  data for analysis of a specific group or area
• Descriptive epidemiologic study - examines the
  amount and distribution of a disease or health
  condition in a population by person, place, and
  time
• Community forum/town hall meeting - qualitative
  method that obtains community opinions by
  selective invitation of participants
• Focus group - obtains grassroots opinions via
  small group process with members being
  homogeneous in regards to demographic variables

9
Data Sources

• Primary Data - talking with community members,
  including formal and informal leaders, and
  community inhabitants for accurate insights and
  comprehensive information
• Secondary Data - includes health team
  information, client records, community health
  statistics, Census Bureau data, reference books,
  research reports, and community health nurses
• Agencies - local (Chamber of Commerce, City
  Planners), state (Dept of Health), national
  (USPHS, Census, NIH), and international (WHO)
• Maps and web sites

10
Analysis and Diagnosis Process

• Analyze the information gathered by recording,
  tabulating, and synthesizing for patterns and
  trends
• Draw inferences or conclusions about the datas
  meaning
• Validate the inferences by rechecking or
  comparing to determine their accuracy
• Form a nursing diagnosis using standard format,
  substituting communtiy as client, relating
  factors within the community health domain

11
Characteristics of a Healthy Community

• A sense of unity
• The ability to collaborate and communicate
  effectively
• A problem-solving orientation
• The ability to use yet conserve resources
• The ability to handle crises and conflict