Community as Client: Applying the Nursing Process

prepared by : Dr . Soad Alnassry

Out line
Learning objectives
Definitions
What is a Healthy Community?
 Dimensions of the Community as Client
 The Nursing Process Applied to the Community as Client
Community Assessment types
Community Assessment Methods
Sources of Community Data
Community Diagnosis
 Planning to Meet the Health Needs of the Community
Implementing Health Promotion Plans for the Community
Evaluating Implemented Community Health Improvement Plan
LEARNING OBJECTIVES
:Upon mastery of this chapter, you should be able to •
.Describe the characteristics of a healthy community •
.Describe the meaning of community as client •
Articulate three specific considerations of each of the three dimensions of the community •
.as client
.Explain methods the community health nurse might use to interact with the community •
.Discuss methods of community health assessment •
.Compare and contrast five types of community assessment •
.Delineate five sources of community data •
Describe the role of the community health nurse as a catalyst for community •
development
 Definitions
• A community: is a collection of people interacting with one
another because of geography, common interests,
characteristics, or goals. These interactions include social
institutions, such as schools, government agencies, and social
services.
• The concept of community as client refers to a group or
population of people as the focus of nursing service
Healthy community

• What is a healthy community? Just as health for an

individual is relative and will change, all
communities exist in a relative state of health. A
community’s health can be viewed within the
context of health being more than just the absence of
disease and including things that promote the
maintenance of a high quality of life and
productivity
 Healthy community-Cont,d
Four overarching goals for the health of the nation
1. To attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death
2. To achieve health equity, eliminate disparities, and improve
the health of all groups
3. To create social and physical environments that promote good
health for all
4. To promote quality of life, healthy development, and healthy
behaviors across all life stages
• Healthy community-Cont,d

• The National Prevention Strategy (NPS), largely based on

Healthy People 2020 priorities, was developed in 2011 to further
national health improvement efforts.
• The strategic directions provide a strong foundation for all of our
nation’s prevention efforts and include core recommendations
necessary to build a prevention-oriented society.
 Healthy community-Cont,d
Causes of preventable death and major illness

1.Includes,tobacco-free living, preventing drug abuse and

excessive alcohol use.
2.Healthy eating, active living, free from injury and
violence,free living reproductive and sexual health
3.Mental and emotional well-being
DIMENSIONS OF THE COMMUNITY AS
CLIENT
1. Status/people
-morbidity and mortality data identifying the physical,
emotional, and social determinants of health (SDH).
2. Structure of a community
-refers to its services and resources.
3. Process reflects the community’s ability to function effectively.
Dimensions of the community as client -Cont,d
Another perspective
1.Location :community boundaries, location of health services, geographic features, climate,
flora and fauna, and the human-made environment.
Community Boundaries
• Measurements of wellness and illness within a community depend on defining the outer
geographic limits of the unit under consideration and also the more informal boundaries that
are present
Location of Health Services
• When assessing a community, the community health nurse needs to identify the major health
centers and know where they are located
 Dimensions of the community as client -
Cont,d
Geographic Features
• Communities have been constructed in every
conceivable physical environment, and environment
certainly can affect the health of a community
 Dimensions of the community as client -
Cont,d
Climate
• Winter weather patterns are expected to become more variable
as average global temperatures continually increase. Research
findings indicate that there is a relationship between
temperature variability and health outcomes.
 Dimensions of the community as client -
Cont,d
Flora and Fauna
Plant and animal populations in a community are often
determined by location. The way a community responds to these
populations, whether wild or domesticated, can affect the health
of the community.
 Dimensions of the community as client -
Cont,d
2. Population variables: size, density, composition or demography,
rate of growth or decline, cultural characteristics, social class structure, and
mobility
 The size of a community also influences the presence of inadequate
housing, the heterogeneity of the population, and almost every conceivable
aspect of health needs and services
Knowing a community’s size provides community health nurses with
important information for planning.
 Dimensions of the community as client -
Cont,d
Density In some communities, thousands of people are crowded into
high-rise apartment buildings. In others, such as farm communities,
people live great distances from one another.
Composition/Demographics Communities differ in the types of people
who live within their boundaries. A community whose members are
mostly older than age 65 has one set of interests and concerns, whereas
a city with a large number of women in their childbearing years will
have another set of concerns.
 Dimensions of the community as client -Cont,d

 Rate of Growth or Decline Community populations change over time.

Some grow rapidly. The growth as a popular place to live has placed
extreme demands on the environment, along with the provision of health
care and other services. Other populations may experience a decline
because of economic change
 Cultural Characteristics
• A community it may be made up of many cultures or subcultures.
• These differences can create conflicting or competing demands for
resources and services or create intergroup hostility.
 Dimensions of the community as client -
Cont,d
Social Class and Educational Level Social class refers to the ranking of
groups within society by income, education, occupation, social class, or a
combination of these factors.
Mobility
People move to go to college, take a new job, join other family members or
friends, or seek a new climate after retirement. This mobility has a direct
effect on the health of communities. If the population turnover is extensive,
continuity of services may suffer.
 Dimensions of the community as client -
Cont,d
3. Social System
• These variables include health, family, economic, educational, religion,
welfare, political, recreational, legal, and communication. Whether assessing
a community’s health, developing new services for the mentally ill within
the community, or promoting the health of the elderly
• The Health Care Delivery System as Part of the Social System
• Although community health nurses must examine all the systems in a
community and must understand how they interact, the health system is of
particular importance.
 THE NURSING PROCESS APPLIED TO
THE COMMUNITY AS CLIENT
• Consisting of a systematic, purposeful set of interpersonal actions, the nursing process
provides a structure for change that remains a viable tool employed by the community
health nurse.
 First , it is problem-solving process that addresses community health problems at every
aggregate level with the goals of preventing illness and promoting public health.
 Second, it is a management process that requires situational analysis, decision-making,
planning, organization, direction, and control of services, as well as outcome evaluation.
 Third, it is a process for implementing changes that improve the function of various
health-related systems and the ways that people behave within those systems.
 Nursing process characteristics
1. Deliberative.
• Community health nurses often practice in situations that demand the ability to
think independently and make difficult decisions.
2. Adaptable
• Its dynamic nature enables the community health nurse to adjust appropriately to
each situation and to be flexible in applying the process to aggregate health needs.
3. Cyclical
• The nursing process is cyclical and in constant progression.
• The nurse engages in continual interaction, data collection, analysis, intervention,
and evaluation.
4.Client Focused
• The nursing process is client focused; it is used for and with
clients. Community health nurses use the nursing process for
the express purpose of addressing the health of populations.
5. Interactive
• The nursing process is interactive, in that nurse and clients are engaged in
a process of ongoing interpersonal communication.
6. Need Oriented
• Although problem solving is certainly an appropriate use of the nursing
process, the community health nurse can also use the nursing process to
anticipate client needs and prevent problems.
Interacting with the Community
• All steps of the nursing process depend on reciprocal interaction,
communication , paving way for helping relationship, aggregate application
• When a community health nurse initially contacts a group of community
leaders, for example, any information the nurse may have in advance can
give only partial clues to that group’s needs and wants. Through open and
honest sharing, the nurse (and others on the health team) will begin to
develop trust and establish lines of effective communication.
Forming Partnerships and Building Coalitions
• The nurse collaborate with other professionals. Usually, the nurse is part
of an organized team, separate from the agency that employs the nurse.
The team is brought together with the goal of improving the health of the
community.
Types of Community Needs Assessment
Community health assessment-is the process of determining the real or
perceived needs of a defined community.
TYPES :
1. Familiarization
Familiarization assessment involves studying data already available on a
community and then gathering a certain amount of firsthand data in order to
gain a working knowledge of the community.
 Types of Community Needs Assessment-Cont,d
2. Problem-oriented assessment, begins with a single problem and assesses the
community in terms of that problem.
3. Community Sub-system Assessment
• In community subsystem assessment, the community health nurse focuses on a
single dimension of community life. For example, the nurse might decide to
survey churches and religious organizations to discover their roles in the
community.
4. Comprehensive Assessment
• Comprehensive assessment seeks to discover all relevant community health
information. It begins with a review of existing studies and all the data presently
available on the community.
Types of Community Needs Assessment-Cont,d

5.Community Assets Assessment

• This method of assessment focuses on the strengths and capacities of a
community rather than its problems
COMMUNITY ASSESSMENT METHODS

1. Surveys
• A survey is an assessment method in which a series of questions is used to
collect data for analysis of a specific group or area. Surveys are commonly
used to provide a broad range of data that will be helpful when used with
other sources or if other sources are not available.
2. Descriptive Epidemiologic Studies
• which examines the amount and distribution of a disease or health condition
in a population by person, place and time
 Community Assessment Methods-Cont,d

3. Community Forums and Social Media

• The community forum or town hall meeting is a qualitative assessment method
designed to obtain community opinions. It takes place in the neighborhood of the
people involved, perhaps in a school gymnasium or an auditorium.
4. Focus Groups
• Is similar to the community forum or town hall meeting in that it is designed to obtain
grassroots opinion. However, it has some differences. First, only a small group of
participants, usually 5 to 15 people, is present. The members chosen for the group are
homogeneous with respect to specific demographic variables.
 SOURCES OF COMMUNITY DATA
• Primary and Secondary Sources
1. Primary data :Information gathered by talking to people
2. Secondary data : health team members, client records, community
health (vital) statistics, census data, reference books, research reports
3. International data : are collected by several agencies, including the
World Health Organization (WHO) and its six regional offices and health
organizations
 Sources Of Community Data-Cont,d

4. National sources
• Community health nurses can access a wealth of official and nonofficial
sources of national data
5. State and Local Sources
• the most significant state source of assessment data comes from the state
health department. This official agency is responsible for collecting state
vital statistics and morbidity data.
 Data Analysis and Diagnosis
• Data validation: Are they accurate, complete, representative of the
population .Data can be rechecked by the community assessment team
and others. Subjective and objective data can be compared.
• Data analysis : Some computer programs are designed to analyze
community assessment data. For large, complex, or ongoing community
assessment plans
• Data interpretation: the ever-present danger exists of making inaccurate
assumptions and diagnoses.
Community Diagnosis :
• Data have been gathered from a variety of sources and have been validated
by several means. The data have been recorded, tabulated, analyzed, and
synthesized, so that patterns and trends can be seen. The community
assessment team should present their findings to peers and colleagues and
use their expertise to assist in the formulation of the community diagnoses
• Validation of data ------ analysis -------interpretation ---community
diagnosis
 :Community diagnosis should

 Include the community response, and identify any related factors that have
potential for change through community health nursing.
 Include wellness diagnoses, which indicate maintenance or potential change
responses (due to growth and development), when no deficit is present.
Community nursing diagnoses
 Include statements that are narrow enough to guide interventions, have logical
linkages between community responses and related factors
 Include factors within the domain of community health nursing intervention.
 PLANNING TO MEET THE HEALTH
NEEDS OF THE COMMUNITY
Planning is the logical decision-making process used to design an orderly,
detailed series of actions for accomplishing specific goals and objectives.

Tools to Assist with Planning :

• Include objectives and activity descriptions , setting priorities
• Conceptual framework and models
• Systematic approach guides the community health nurse in the development
of a feasible plan that adequately and appropriately addresses the needs of the
community
 : The Health Planning Process

The health planning process is a four-stage system used to design

new health-related programs or services in the community.
• 1. Assessment stage
• 2. Analysis and Design
• 3. Implementation stage
• 4. Evaluation stage
IMPLEMENTING HEALTH PROMOTION
PLANS FOR THE COMMUNITY
1. Preparation
• The actual course of implementation, outlined in the plan, should be fairly
easy to follow if goals, expected outcomes, and planned actions have been
designed carefully. Professionals and clients should have a clear idea of
who, what, why, when, where, and how. Who will be involved in carrying
out the plan? What are each person’s responsibilities? Do all understand
why and how to do their parts? Do they know when and where activities
will occur?
2. Activities or Actions
• The process of implementation requires a series of nursing actions or
activities.The nurse applies appropriate theories, such as systems theory or
change theory, to the actions being performed.
 EVALUATING IMPLEMENTED COMMUNITY HEALTH
IMPROVEMENT PLAN

Evaluation refers to measuring and judging the effectiveness of goal or

outcome attainment
Types of Evaluations
1.Formative -evaluation is on process during the actual interventions.
2.Summative - evaluation focuses on the outcome of the interventions
Reference :
Cherie Rector, Community and Public Health Nursing Promoting the Public ’ s Health :
Ninth Edition .Copyright © 2018 Wolters Kluwer
https://pubhtml5.com/dhqc/dldj/basic Chapter 15

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