Community Assessment

Identify Strengths and Health Concerns

Interpretation of community data occurs about community concerns, community strengths, and feasibility studies. Community nurses make judgments and inferences about community health, community responses to health situations, and population needs. One approach assumes health concerns exist unless assessment data indicate otherwise (Gordon, 2011). Other systems of assessment base decisions on community strengths. With the problem-focused assessment of health concerns, nurses make diagnoses based on summarized data using the nursing process, which results in one or more of the following determinations:

•No problem exists, but providing health-promotion or health-protection services may address a potential health concern. For example, providing health education in a high school could offset a potential for increased sexually transmitted disease in the high school population.

•A problem exists but is recognized by community members or health-related professionals with effective strategies for problem-solving; for example, flu immunizations.

•A problem exists that the community recognizes, but resources are inadequate, or the community has not responded. Assistance is needed; for example, highway traffic noise.

•A problem exists that the community recognizes but cannot cope with at this time, such as a lack of fluoridated water systems. Dentists, nurses, and nutritionists could be assigned to assist the community in resolving actual problems of dental caries.

•A problem or potential health concern exists that needs further study; for example, lack of sidewalks.

Using strength-based approaches to assessment emphasizes strengths and integrates health-promotion and health-protection activities into their plans. For example, a community may have nutritional feeding programs for older adults, women, and children that are underutilized. Community members may not use them because communication is inadequate. Examples of community strengths and concerns are shown in Table 8-3.

Identify Causes and Risk Factors

Data are examined for factors or characteristics that contribute to identified potential and existing health-related concerns. Nurses make inferences about population groups and identify risk factors. Identifying risk factors guides community nursing actions. Some risk factors signify immediate health concerns, such as polluted water supply, whereas other risk factors indicate potential problems, such as lack of knowledge about childhood disease prevention. Nurses consider whether community risk factors can be altered, eliminated, or regulated through nursing actions. Nurses modify factors when possible by using strategies such as health education

TABLE 8-3 EXAMPLES OF COMMUNITY STRENGTHS AND CONCERNS

STRENGTHS	CONCERNS
Well-child clinic available	Unavailable
Feeding program accessible to older adults	Inaccessible
Sex education in schools acceptable	Unacceptable
Family planning services accessible	Inaccessible
Fluoridated water system	Nonfluorinated water system
Open communication	Dysfunctional communication
Interagency cooperation	Dysfunctional transactions
Adequate kitchen and plumbing facilities	Inadequate
High interest of key leaders in health promotion	Lack of interest

Guidelines for Data Analysis

Check for Missing Data

Complexity, size, and number of community characteristics prohibit gathering all possible facts about the health-related pattern areas; however, missing or insufficient data that indicate areas for further assessment should be identified. Additional assessment may determine specific approaches or a community diagnosis. Examples of missing data in community assessment include pollution indices, links between health resources and population groups, accessibility to resources, and morbidity statistics. Dates for census data used should be noted.

The nurse examines community data for incongruities and conflicting information. For example, a key community official might deny the existence of pollutants in the water supply, whereas newspaper reports of health department water analysis findings indicate otherwise. The nurse evaluates such inconsistencies before identifying existing or potential health concerns.

Identify Patterns

Clues about a community pattern emerge from subjective and objective data gathered. During this stage, community nurses make decisions, begin to formulate diagnostic hypotheses (ideas and tentative judgments about possible health concerns), identify community groups that might be at risk, and establish probable causes or relationships. Ideas generated from this activity direct the search for additional clues in the data to confirm, reject, or revise hypotheses. Judgments about hypotheses continue to support patterns in the data.

To narrow the huge list of possible community health-promotion and health-protection concerns, community nurses formulate broad problem statements based on the health-related pattern areas (Gordon, 2011). For example, the community nurse differentiates among elimination problems (e.g., noxious chemicals), coping and stress-tolerance problems, and health perception–health management problems (e.g., high teenage mortality rate from motor vehicle accidents). Developing these general categories facilitates analysis.