Your Community Assignment

Assessment

Faith

Community

Nursing

Gail Williams,RN, MSN, FCN

Foundations of Faith

Community Nursing

Curriculum

www.churchhealthcenter,.o

rg; 2014)

Types of Communities

Geographical

Geopolitical

Phenomenological

Circumscribed

Aggregate

(Stanhope and Lancaster, 2014)

Dimensions of Community

Health

Status

Structure

Process

Status

The biological or physical part of community is measured in

these ways:

 total population demographics

 age distribution in years

 marital status

 racial and ethnic composition

 morbidity and mortality rates

Status (continued)

life expectancy indexes

risk factor profiles

birth and death rates

maternal and infant death rates

incidence of low birth weight

number of teen births

causes of death

Status (continued)

The emotional part of a community is measured in these

ways:

 consumer satisfaction

 mental health indices

 communicable disease incidence, and behavioral risk factors

Status (continued)

The social part of community is measured in these ways:

 crime rates

 systems functional levels

 system literacy level

 homeless rate

 educational achievement levels

Structure

The social part of community is measured in these ways:

 crime rates

 systems functional levels

 system literacy level

 homeless rate

 educational achievement levels

Structure, cont.

This category of community assessment includes services

and resources, service use patterns, treatment data from

various health agencies, provider-to-client ratios, health

manpower, health planning groups, and partnerships

Structure, cont.

Health and social services include:

 availability of acute care hospitals

 mental health services

 long-term and rehab services

 number of physicians, dentists and registered nurses

 home health services, complementary and alternative health

providers, accessibility of Social Security Medicaid and

Medicare offices

Structure, cont.

 child protective services

 shelters for the homeless

 services for victims of domestic violence

 meal delivery services

 respite care for children and adults with special needs

 adult day care

 substance abuse programs

Structure, cont.

Transportation assessments measure these factors:

 amount of travel to and from work

 method of transportation to and from work

 accessibility to public transportation

 taxi services

 transportation services for the elderly

 method of transportation that might affect the ability of

members of the faith community to attend worship services or

receive health care services

Structure, cont.

Spiritual resource assessments look at these

considerations:

 number and diversity of places of worship

 spiritual activities in the area

 types of other health ministries, religious coalitions or

collaborations existing in the community (Lucchetti et al., 2013)

Process

Assess processes that may indicate that the community can function effectively in these areas:

 collaboration between community groups

 community problem identification

 community consensus on goals, priorities, and strategies

 community links to the rest of the world through radio, television, Internet

 availability of Internet services to homeowners and general public

(Stanhope and Lancaster, 2014)

Methods of Assessment

Windshield survey

Participant observation

Informant interviews

Statistical data

Reported data

Key Term: Windshield

Survey

driving or walking through an area and making organized

observations

Best to have someone do the navigating while you assess

Windshield Survey

The following elements should be considered: (Stanhope & Lancaster, 2014)

 housing and zoning

 open space

 boundaries

 commons

 transportation

 service centers

 Physical state of these areas

Collection of Reported Data

Collect information from census data.

Compare data from faith community to regional and state

statistics. This comparison may give relevance and meaning

for the faith community.

(Stanhope and Lancaster, 2014)

Assessment of the Faith

Community’s

Administrative Staff

A key element prior to getting a health ministry off the

ground is to first be accepted as a faith community

ministry.

It needs to be very clear to the faith community just what

this ministry is going to do and how it will be done.

Assessment of the Faith

Community’s Administrative

Staff (continued)

It is vital that there is significant support from the spiritual

leader, administrative staff, and board members for this

ministry to be successful. (McNamara, 2014)

Assessment of the Faith

Community’s Administrative

Staff (continued)

Assess the structure of the faith community.

Who comprises the ministry staff, and what is the

hierarchy?

Who are the faith community leaders (official and

unofficial)?

What areas of responsibility does each staff member

have?

Assessment of the Faith

Community’s Administrative

Staff (continued)

Do both men and women serve in all roles, or are roles

gender-based?

Is there an existing committee structure? Does it include

a health ministry? If so, what services does it currently

provide?

Are the human and financial resources adequate to meet

community needs?

Assessment of the Faith

Community’s Administrative

Staff (continued)

Assess the process of how the faith community functions.

What is the mission of the faith community?

What is the governing body of the faith community?

Are lay leaders elected or appointed by the clergy?

Assessment of the Faith

Community’s Administrative

Staff (continued)

Who are decision makers in the faith community?

Who must be consulted to approve plans and programs?

Who develops and manages the faith community

budget?

Critical Thinking

Why is the comparison of data from your faith community

to census bureau and local health department data

valuable?

How will determining community assets support health in

the community at large?

What to Assess?

What are the member demographics?

What births and deaths have occurred?

What age groups are heavily represented in the faith

community?

What attributes, gifts or strengths do members have?

Have any members been trained as emergency first

responders?

Have members been trained as health promoters?

What to Assess? (continued)

Are members willing to participate in these ways?

transportation

cooking and preparing meals for families in need

lawn care

home calls, e-mail messages, sitters, hospital companions

leadership of volunteer activities

What to Assess? (continued)

What are the predominant health concerns?

What are some of the things about your health or your

family’s health that concern you at this time?

When you are not feeling well, with whom do you usually

speak?

What to Assess? (continued)

Do you believe the faith community has a role in helping

meet the health needs of members? How important is

this?

What types of services would you like to see the faith

community and the FCN establish to help you better

meet your health needs?

What day and time works best for attending educational

programs?

What to Assess? (continued)

What are some evident dynamics within the faith

community?

What is the relational community—the sense of

connection between members?

What is the shared history of the faith community?

Is it a safe place for collective memories, hopes, and

dreams?

Are there shared emotional connections?

What to Assess? (continued)

What is the best method to assess spirituality of the

congregation and individual members?

 The FCN can explore an individual’s faith or beliefs and the

influence of such on their health and illness.

 The FCN will determine the status of spiritual well-being versus

spiritual distress.

 Spiritual assessment leads the FCN in the direction of needed

screenings.

What to Assess? (continued)

According to The Joint Commission on Accreditation of

Healthcare Organizations (TJC), practitioners should

conduct an initial, brief spiritual assessment with clients in

many settings, including hospitals and behavioral health

organizations providing addiction services.

Key Term: Spiritual History

a set of questions designed to invite patients to share their

religious or spiritual beliefs in order to help identify spiritual

issues

Spiritual Assessment

Questions

Who or what provides the patient with strength and hope?

Does the patient use prayer in his or her life?

How does the patient express spirituality?

How would the patient describe his or her philosophy of

life?

What type of spiritual or religious support does the patient

desire?

Spiritual Assessment

Questions (continued)

What is the name of the patient’s clergy, ministers,

chaplains, pastor, or rabbi?

What does suffering mean to the patient?

What does dying mean to the patient?

What are the patient’s spiritual goals?

Is there a role of church or synagogue in the patient’s life?

Spiritual Assessment

Questions (continued)

How does faith help the patient cope with illness?

How does the patient keep going day after day?

What helps the patient get through this health care experience?

How has illness affected the patient and his or her family?

Spiritual Assessment

Instruments

FAITH (Neely et al., 2009)

This instrument analyzes five dimensions (Faith/spiritual

beliefs, Application, Influence/ importance, Talk/terminal

events, and Help) and proposes 16 questions. It is easy to

use, broad, and can be used in all settings.

Spiritual Assessment

Instruments (continued)

FICA (Puchalski et al., 2000)

This instrument analyzes four dimensions (Faith or beliefs,

Importance and Influence, Community, and Address) and

proposes 11 questions. Health professionals in all settings

can use it.

Spiritual Assessment

Instruments (continued)

SPIRITual History (Maugans, 1996)

This instrument analyzes six dimensions (Spiritual belief

system, Personal spirituality, Integration with spiritual

community, Ritualized practices and restrictions,

Implications for medical care, and Terminal events) and

proposes 22 questions.

Spiritual Assessment

Instruments (continued)

HOPE (Anandarajah, and Hight, 2001)

This questionnaire asks questions that cause the

participant to examine his or her sources of hope, the

influence of organized religion on his or her life, personal

spirituality and practices, and effects on medical care and

end-of-life issues.

Spiritual Assessment

Instruments (continued)

Royal College of Psychiatrists (Culliford et al., 2006)

This instrument was developed by psychiatrists for mental

health professionals. It analyzes different dimensions such

as meaning, major losses, coping, and support. It analyzes

the relationship between spirituality and religious aspects

in the past, present, and future of the patient’s life.

Health Assessment Tools

Family Health Assessment should include the following

areas:

 cultural or ethnic background

 religious identification

 family’s recreational or leisure activities

 developmental stage and history of family

 environmental data: characteristics of home, neighborhood

and larger community, family’s social support network

Health Assessment Tools (continued)

family’s communication patterns, power and role

structure,

family values

family functions such as nurturance, closeness

socialization function, such as child rearing practices,

value of children in family

health care function, such as family’s health beliefs, values,

dietary practices, sleep and rest habits, drug habits, and

role in self-care practices, dental health practices,

perceptions regarding health services

Health Assessment Tools (continued)

family stress and coping, such as coping strategies and

dysfunctional adaptive strategies utilized

Health Assessment Tools (continued)

The Friedman Family Assessment Model (2003) includes the following identifying data:

 Family name

 Address and phone number

 Family composition (genogram)

 Type of family form

 Cultural and ethnic background—extent of acculturation

Health Assessment Tools (continued)

Religious identification

 family religion

 family members differing in religious beliefs and practices

 how actively involved the family is in church, temple, mosque, or other religious organizations

 religious practices the family engages in

 religious beliefs and values central in family life

Health Assessment Tools (continued)

Social status—occupation, education, income

 estimated family social class

 identity of income earners

 source of supplementary income

 whether the family considers the income adequate

Social class mobility

Health Assessment Tools (continued)

A family health history (accessed at

https://familyhistory.hhs.gov/fhh-web/home.action) can

help identify whether individuals have higher risk for some

diseases. It can help the FCN look for early warning signs of

disease and guide recommended actions for reducing

personal risk of disease.

Data Collection

Developing a therapeutic relationship is crucial.

 Talk in a nonthreatening environment.

 Establish trust, rapport and presence.

 Listen to the individual’s perception of illness and potential

strategies to solve the problem.

Methods of Data Collection

Questionnaires

One-on-one interviews

Key informants

Home visits

Home Visits

Primary tool for assessing an individual or family

Appropriate planning

 Who initiated the visit? The faith community’s spiritual leader,

a family member, a friend, or the person you are visiting?

 Who is the reason for the visit? Is it to welcome a new baby?

 Has an older member just been discharged from the hospital

and is in need of assessment for home health services?

Home Visits (continued)

Has the individual recently lost a loved one or a beloved

pet?

Is this someone with whom you have a relationship, or is

this a “cold” visit?

Is it in a safe location? Do you need to be concerned with

pets?

Have you scheduled the visit for a time that is convenient

for the family?

Home Visits (continued)

On the day of implementation, remember that you are a

guest.

 Maintain a relaxed environment.

 Maintain privacy and confidentiality

 Use your observation skills.

 Invite the person to show you the home.

 Ask them what their needs are.

 If you are visiting a family, how often do they have dinner

together?

 Be respectful and courteous.

Critical Thinking

When do you think it would be necessary to do a

comprehensive individual health assessment?

What are some important aspects that the FCN should

assess when making visits?

Designing Programs

Address most prominent health-related issues.

Look for common threads and gaps.

List assets of the faith community.

Develop a nursing diagnosis.

Nursing Diagnosis

Actual, potential or perceived threat

3-part diagnosis

- risk of

- among

- related to

Nursing Diagnosis (continued)

 Example: Risk of caregiver role strain among elderly

caregivers in Crystal Faith Community related to

inadequate social services and lack of custodial care.

Priorities for Programming

Those requests with largest number of respondents

Those requests that the FCN and health ministry team can

most readily and appropriately respond to

Set individualized, realistic, measurable goals and

outcomes

Consider resources

Recognize personal boundaries

Critical Thinking

What are the advantages of a systematic assessment of a

faith community?

How will the FCN know if needs of the faith community

have been met?