PRINCIPLES OF COMMUNITY HEALTH"

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Chapter 7

Community Health Planning, Implementation, and Evaluation

The Community as Client

Figure 7-1

Levels of

Community Health Nursing Practice

Client Example Characteristics Health

Assessment

Nursing

Involvement

Individual Lisa McDonald Individual with various

needs

Individual strengths,

problems, and needs

Client-nurse interaction

Family Moniz family Family system with

individual and group

needs

Individual and family

strengths, problems, and

needs

Interactions with

individuals and the family

group

Group Boy Scout

troop

Alzheimer’s

support group

Common interests,

problems, and needs

Interdependency

Group dynamics

Fulfillment of goals

Group member and

leader

Population

group

AIDS patients

in a given state

Pregnant

adolescents in

a school

district

Large, unorganized

group with common

interests, problems, and

needs

Assessment of common

problems, needs, and

vital statistics

Application of nursing

process to identified

needs

Organization A workplace

A school

Organized group in a

common location with

shared governance and

goals

Relationship of goals,

structure,

communication, patterns

of organization to its

strengths, problems and

needs

Consultant and/or

employee application of

nursing process to

identified needs

Community Italian

neighborhood

Anytown, USA

An aggregate of people

in a common location

with organized social

systems

Analysis of systems,

strengths,

characteristics,

problems, and needs

Community leader,

participant, and health

care provider

Health Planning Model

Figure 7-2

Hogue (1985)

Steps in the Health Planning

Model

 Assessment  Meet with group leaders of aggregate to clarify mutual

expectations

 Determine sociodemographic characteristics

 Interview a key informant

 Consider both positive and negative factors

 Compare the aggregate with the “norm”

 Research potential problems

 Identify health problems and needs

 Prioritize the identified problems and needs to create an effective plan

Four Types of Needs to Assess

 Expressed needs

 Demand for services and the market behavior of the targeted

population

 Normative needs

 Lack, deficit, or inadequacy of services determined by health

professionals

 Perceived needs

 Wants and desires expressed by audience

 Relative needs

 Gap showing health disparities between advantaged and

disadvantaged population

Factors for Determining Priorities

 Aggregates preferences

 Number of individuals affected by the health

problem

 Severity of the health need or problem

 Availability of potential solutions

 Practical considerations such as skills, time,

and available resources

 May use Maslow’s hierarchy of needs or

levels of prevention to further refine priorities

Community Involvement Is Essential

“Start where the people are!”

 Five spheres of empowerment

 Interpersonal (personal empowerment)

 Intragroup (small group development)

 Intergroup (community)

 Interorganizational (coalition building)

 Political action

– Labonte (1994)

Steps in the Health Planning Model

(Cont.)

 Planning

 Determine the intervention levels

• Subsystem, aggregate system, and/or suprasystem

 Plan interventions for each system level

• Primary, secondary, or tertiary levels of prevention

 Validate the practicality of the planned

interventions according to available resources

• Personal, aggregate, and suprasystem

Development of Goals and

Objectives

 Goals—where we want to be

 Objectives—steps needed to get there

 Measurable

 Specific measures

 Instructions to guide population

 Used to measure outcomes

Steps in the Health Planning Model

(Cont.)

 Intervention

 Often the most enjoyable stage for the nurse and

the clients

 Implementation should follow the initial plan

 Should include a variety of strategies

 Prepare for unexpected problems

Interventions by

Type of Aggregate and System Level

Project Type of Aggregate System Level for Intervention

Rehabilitation group Group Subsystem and aggregate system

Textile industry Organization Aggregate system and suprasystem

Crime watch Group, organization,

and population group

Aggregate system and suprasystem

Bilingual students

(case study)

Community Aggregate system and suprasystem

Steps in the Health Planning Model

(Cont.)

 Evaluation

 Include the participant’s verbal or written feedback and the

nurse’s detailed analysis

 Reflect on each previous stage to determine the plan’s

strengths and weaknesses

 Evaluate both formative (process) and summative

(product/outcome) aspects

 Communicate follow-up recommendations

Importance of Each Step in the

Nursing Process

 Aggregate assessments must be thorough.

 Should elicit answers to key questions about the aggregate’s

health and demographic profile

 Should compare this information with similar aggregates

presented in the literature

 The nurse must complete careful planning and set

goals that the nurse and the aggregate accept.

 Mutual planning is very important.

 Interventions must include aggregate participation

and must meet the mutual goals.

 Evaluation must include process and product

evaluation and aggregate input.

PRECEDE-PROCEED Model

Federal Legislation Affecting Health

Planning

 Hill-Burton Act

 Regional Medical Programs (RMP)

 Partnership for Health Program (PHP)

 Certificate of Need (CON)

 National Health Planning and Resources

Development Act

Comprehensive Health Reform

 Patient Protection and Affordable Care Act

(2010)

 Preventive services based on evidence-based

recommendations

 National strategy to improve the nation’s health

 CMMS innovation center

 National quality improvement strategy for services

and population health

 Improved access to care

 Reduction in the growth of Medicare spending

 National workforce strategy

Nurses’ Role

 Work collaboratively with health planners to

improve aggregate health

 Fuse technology with knowledge of health

care needs and skills

 Become directly involved in the planning

process

 Engage in aggregate-level projects