Community Assessment

1/ The Nature of Community:

❖ Many dimensions design the nature of community.

❖ These include:

→ Aggregate of People.

→ Location in Space and Time.

→ Social System.

Aggregate of People:

❖ Aggregate is a community composed of individuals who share common characteristics.

❖ Members of a community may share the same city, membership, religion, or similar

demographic characteristics like age and ethnic background.

❖ For example, the aggregate of senior citizens who share ages, economic pressures, life

experiences, interests, and concerns.

❖ Many elderly people share concern for the promotion of good health, the maintenance of an

active lifestyle, and the security of needed services to support their quality life.

❖ Communities also may be formed of overlapping aggregates, in which some community

members belong to multiple aggregates.

❖ Many human factors help describe community:

→ Health-related traits.

→ risk factors.

❖ for example, people with acquired immunodeficiency syndrome (AIDS), or people at risk for a

second myocardial infarction may consider themselves as a community.

❖ A community of solution: form when a common problem exists. then, Disintegrates After

problem resolution.

Location in Space and Time:

❖ Regardless of shared features, geographic or physical location may define communities of

individuals.
 ❖ Traditionally, a community is a landmark by geopolitical boundaries.

❖ Census tracts subdivide larger communities and help define and describe neighborhood

communities.

❖ Geographic location, including the urban or rural nature of a community, strongly influences the

nature of the health problems.

❖ community health is recognizing that the interaction of individuals with their natural

environment and constructed environments (built environment) consisting of buildings and

spaces, is vital to healthy behavior and quality of life.

Social System:

❖ the community is a complex social system, their members interact together to form a various

subsystem within the community.

❖ An example of a complex system is a health care system that consists of smaller, interrelated

subsystems.

❖ A health care system can be also a subsystem because it interacts with a larger system such as

the government system.

❖ Changes in the larger system can affect in many subsystems.

❖ Incidence of health problems also can have impact on multiple systems.

❖ When local economic pressures exist, the health department may eliminate or cut back programs,

limit service to other health care providers, reduce access to groups that normally use the system.

❖ For example, In San Francisco, the distribution of funds for AIDS programs initially reduced

funding for other programs, such as immunizations, family planning, and well-childcare.
2/ Healthy Communities

❖ The ability of the community to respond effectively to change and meet the needs of its

members indicates productive functioning.

❖ Assessment parameters that can help a public health nurse to develop a more complete list of

community functions:

❖ Examining the community’s functions and subsystems provides clues to potential health

problems.

❖ Community Competence referred to capacity of the communities to address future problems.

health nurses and health professionals work with communities' members in developing effective

solutions that are acceptable to communities.

❖ Indicators of community strength :

→ able to foster open communication.

→ able to commitment to a healthy future.

→ able to participate in problem identification.

→ active involvement of health department that can assist a community with health issues.

→ extent to which members have successfully worked together.

❖ A public health nurse must demonstrate these initial assessments before formulating a

community diagnosis and plan.

❖ The public health nurse becomes familiar with the community and understand its nature by

moving around the area.

❖ shoe leather epidemiology: it is approach in which the nurse begins to establish certain hunches

or hypotheses about the community’s health, strengths, and potential health problems.

4-a/Sources of Data

→ Windshield Survey

→ Census Data

→ Vital Statistics

→ Other Sources of Health Data

Windshield Survey

❖ public health nurses perform a community windshield survey by driving or walking around the

area and making her observations.

❖ The windshield survey offers opportunity to the public health nurse to observe people and their

role in the community.

❖ The nurse can understand the environmental layout, including geographic features and the

location of agencies, services, and industries, and can locate possible areas of environmental

concern through “sight, sense, and sound.”

❖ Guidance to windshield survey assessment:

→ Community vitality.

→ Indicators of social and economic conditions.

→ Health resources.

→ Environmental conditions related to health.

→ Social functioning.

→ Attitude toward health and health care.

❖ In U.S. Every 10 years, Census Bureau undertakes a survey of all American families, these

statistical data describe the population characteristics.

❖ The census including many demographic variables which include population size and the

distribution of age, sex, race, and ethnicity.

❖ The Community Survey conduct a social data reports such as income, poverty, and occupational

factors.

❖ The nurse analyzes data by comparing current census data with previous data landmark key local

differences and changes over time.

❖ The official registration records of births, deaths, marriages, and divorces are the basic data in

vital statistics.

❖ Vital statistics provide indicators of population growth or reduction When compared with those

from previous years.

❖ Birth certificates provide birth information (e.g., cesarean delivery, prenatal care, and teen

mothers) and the occurrence of any congenital malformations.

❖ In addition to provide information regarding the number of births and deaths, registration

certificates usually record the causes of death, which is useful in determining morbidity and

mortality trends and assessments of the community's health status.

Other Sources of Health Data

→ The National Center for Health Statistics (NCHS): conduct annual reports on the prevalence of

disability, illness, and other health-related variables.

→ Behavioral Risk Factor Surveillance System: it is a website allows to describe specific risk

behaviors that emerging health problems.

→ Government reports that contribute to the comprehensive assessment of a population.

→ Local agencies, chambers of commerce, and health and hospital districts collect invaluable

information on their community’s health.

❖ The public health nurse can use these formal and informal resources to understand the

community or aggregate.

❖ recently, data about population health are stored in many places.

❖ Finding the latest statistics at the local or national level can be a challenging experience for a

student, community health nurse, graduate student, or nurse researcher.

❖ The following guidelines suggest places to begin a search:

→ Reference Librarian

→ Government Documents

→ Morbidity and Mortality Weekly Report (MMWR)

→ Centers for Disease Control and Prevention

❖ The purpose from needs assessment is to identify the strengths and weaknesses, determine gaps in

service and measure the community members satisfaction.

❖ engaging individual in the community into the planning of the assessment can create trust and

ownership in the process, and subsequently in the improvements that result.

Steps in the Needs Assessment Process:

1. Identify aggregate for assessment.

2. Engage community in planning the assessment.

3. Arrange for a sample representative of the aggregate.

4. Identify required information.

5. Develop questionnaire or interview questions.

6. Select method of data gathering.

7. Develop procedures for data collection.

8. Train data collectors.

9. Tabulate and analyze data.

10. Identify needs suggested by data.

11. Conduct needs assessment.

12. Develop an action plan.

6/Diagnosing Health Problems

❖ The next step in nursing process is created a list of all actual and potential problems in format

writing (diagnostic statements).

❖ The diagnosis consists of four components:

→ The health problem or risk.

→ The affected populations.

→ The etiological or cause.

→ The evidence or the sings and symptoms.

❖ Sometimes nurses develop wellness diagnoses.

❖ For example, Increased potential for positive infant outcomes among teenage mothers related to

effective parenting as evidenced by increased participation in mother–baby practice sessions and

positive newborn care behaviors.

❖ Another example, increased risk of undetected testicular cancer among young men related to insufficient

knowledge about the disease and the methods for preventing and detecting it at an early stage, as

demonstrated by high rates of late initiation of treatment.

Summary

❖ To help Specific population, public health nurse needs to be familiar with the nature of a given

community, sources of the data such as local government agencies, census reports, morbidity and

mortality reports, and vital statistics.

❖ Based on this information, the community health nurse can apply the nursing process through

assessment, diagnosis, planning, intervention, and evaluation from the individual client level to a

targeted aggregate in the community.