Chap 15 Community as Client

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Chap 15 Community as Client
2015-02-07 13:16:10
Chap 15 Community Client

Community as Client
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  1. What is a Community
    People and the relationships that emerge among them as they develop and use in common some agencies and institutions and a physical environment
  2. A ____ community attends to and achieves the goals of Healthy People 2020
  3. Community as  Client refers to:
    • Community-wide group of people as the focus of nursing service
    • -community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it
    • -provision of most health services occurs at the community level
  4. A "community practice" setting is _____ reason for saying that practice is oriented toward the community client
    • ie: when the location of practice is in the community but the focus of practice is the individual or family, the nursing client remains the individual or family, not the whole community
  5. Community as the client requires that _____ remains the overall goal of nursing intervention:
    Improved health of the community
  6. Goals and Means of Community Oriented Practice
    GOAL: Nurse and Community seek healthful change together
  7. 3 Common Characteristics of Community Health:
    Status, Structure, and Process
  8. Outcomes of Community Nursing are focused on:
    • Physical
    • Emotional
    • Social
  9. Examples of Community nursing outcomes
    • Vital statistics
    • Morbidity and Mortality rates
    • Leading causes of death
    • Mental health
    • Crime rates
  10. The Status of Community Health is assessed by looking at the _____
    Outcomes (physical, emotional, and social)

    • -vital statistics
    • -morbidity/mortality rates
    • -leading causes of death
    • -mental health
    • -crime rates
  11. The structure of community health is based on:
    Treatment, Services and Resources
  12. Examples of Structure in Community Health
    • Hospitals, clinics
    • Health professionals
    • Government structure
    • Population characteristics- demographics
    • ***As socioeconomic levels increase, so does health
  13. As _____ levels increase, so does health in the community
  14. The process of community health is based on:
    Competency of community in meeting members needs
  15. Examples of the Process in community Health
    • Commitment of Members
    • Self and other awareness
    • Articulateness/Communication
    • Conflict resolution
    • Active member participation
    • Management of social interactions
    • Effective resource procurement and uses
  16. Perspectives of community include:
    Location, Population and Social System
  17. Examples of location in community:
    • Community boundaries
    • Location of health services
    • Geographic Features
    • Climate 
    • Flora
    • Fauna
    • Human-Made Environment
  18. Examples of things to assess in a Population in Community
    • Size
    • Density
    • Composition
    • Rate of growth/decline
    • Cultural Characteristics
    • Social Class
    • Education level
    • Mobility
  19. Examples of things to assess in the Social System of community:
    • Variables
    • Health Care Delivery System
  20. 3 Key Steps to the Nursing process in community:
    • Problem-Solving Process
    • Management Process
    • Process of Implementing Change
  21. Characteristics of the Nursing Process:
    • Deliverative; Adaptable; Cyclic 
    • (we want to re-visit everything: assess/re-assess)

    Client Focused; Need Oriented

    • Interaction with Community
    • (communication; reciprocal interaction: they need us, we need them; paving way for helping relationship; aggregate application)

    Forming of partnerships and building of coalitions
  22. Community assessment consists of:
    Critically examining the characteristics, resources, assets, and needs of a community

    Collaboration with that community

    Developing Strategies to improve the health and quality of life of the community
  23. Process of determining real or perceived needs of a defined community
    Community needs assessment
  24. Types of Community Needs Assessments:
    • Windshield Survey (familiarization assessment)
    • Problem-Oriented Assessment
    • Community Subsystem Assessment
    • Comprehensive Assessment (key informants)
    • Communty Assets Assessment
  25. Type of Community Needs Assessment: common starting point; driving around community to scope everything out; very GLOBAL
    Windshield Survey

    IE: targeted goal in obesity --> scope out sidewalks, parks, etc...
  26. Type of Community Needs Assessment: very focused on a single dimension of community
    Community Subsystem Assessment
  27. Type of Community Needs Assessment: Looks at all of the pieces of windshield survey and key informants and comes up with problem, dx and plan
    Comprehensive Assessment
  28. Type of Community needs assessment: focuses on strengths/weaknesses of the environment
    Community Assets Assessment
  29. Always assess the community at different parts of the day because:
    you will get different results
  30. Methods to perform Community Assessment:
    Surveys (how many people have asthma)

    Descriptive Epidemiologic Studies (health concerns/data...ex: community in Conyers with high rate of pregnancy)

    Community forums/town hall meetings

    Focus Groups
  31. Primary sources of community data:
    Gathered by talking to people (key informants)
  32. Secondary sources of community data:
    records produced by people who know the community well
  33. International Sources of Community Data
    WHO, United Nations
  34. National Source of Community Data
    CDC, USDHHS, US Bureau of Census, NIH
  35. State source of community data:
    Chamber of Commerce
  36. Local source of community data:
    Libraries, Hospitals, Community Leaders
  37. Community Dx portray
    A Community Focus
  38. Community Dx include:
    (Dx are logically consistent; response and factors are logically linked)

    -Community response/related factors that have potential for change via Community Health Nursing

    -Statements narrow enough to guide interventions

    -Factors within the domain of community health nursing intervention
  39. Community DX use _____ instead of a risk, goal or need statement
    Community Response
  40. Deficit and Wellness dx of community include:
    maintanence or potential change responses (due to growth and development) when no deficit is present
  41. Measuring or judging the effectiveness of goal/outcome attainment
    Evaluating Implemented Community Health Plans
  42. Types of Evaluations of the Community Health Plan
    Formative (midterm)-- focus on process during actual interventions; development of performance standards

    Summative (final)-- focus on the outcomes of interventions; effect; impact
  43. Type of Evaluation: Focus on process during actual interventions; development of performance standards
  44. Type of Evaluation: focus on the outcomes of interventions; effect; impact
    Summative (Final)
  45. The Community Development Theory is based on the presumption that:
    All community members participate in all aspects of change
  46. Community Development Theory:
    • Outcomes of effective community-level nursing
    • Collaboration with community members to assess collective needs and desires for positive change and address these needs through problem solving, use of community experts, and resource development

    Presumption that all community members participate in all aspects of change

    Agent of change (nurse) is considered a partner not authority figure responsible for community's health

    Outcomes benchmarked against those of other groups
  47. ___ is a prerequisite for effective community-oriented practice and should be a consideration throughout the process
    Personal Safety
  48. Best guidelines for judgement of personal safety in community:
    • Awareness of community
    • Common Sense
    • Background Information
  49. 3 sources of information about a community that will tell you about safety:
    Nurses, Social Workers, HCP who are familiar with dyanmics of given community

    Community members

    Your own observations
  50. Ways to improve personal safety in community setting:
    • Call ahead
    • Be organized
    • Follow instincts
  51. A community assessment includes:
    • History
    • Gathering data (primary and secondary sources)
  52. Data collection that involved directed conversation with selected community members
    Focus Groups Assessment (informant interview)
  53. Type of assessment when the nurse is deliberately sharing in the community life (ie: reading news paper)
    Participant observation
  54. Ways to describe the community of interest
    • Location
    • Geographic Boundaries (water, green space, housing, zoning, structures, road condition)
    • Human made environment (business, pollution, roads, housing, garbage services, side walks)
    • Climate
    • Flora and Fauna
  55. Things to include in population/social systems assessment:
    • Residents
    • Demographics
    • Rate of growth
    • Density
  56. Things to include in Mobility patterns assessment:
    • Private/Public transporation
    • Accomodations for disabled
    • Bike Lanes
    • Sidewalks
  57. Things to include in overall Community Assessment:
    • Location
    • Geographic Boundaries
    • Human made environments
    • Climate
    • Flora/Fauna
    • Population/Social Systems
    • Mobility Patterns
    • Sanitation
    • Police
    • Crime Statistics
    • Occupations/Businesses
    • Family Social Welfare Systems
    • Educational Systems
    • Religious, Government
    • Morbidity/Mortality
    • Employment/Unemployment
    • Occupational categories
    • Median Income (% living in poverty)
    • Hospitals/Emergency services
    • Clinics/HCPs
    • Home Health
    • Nursing Homes/Assisted Living
    • Mental Health Services
    • Schools
    • Libraries
    • Local school boards
    • Dropout rates
    • Educational issues
    • Extracurricular school activities
    • School Health
    • Parks/Playgrounds
    • Facilities
    • Sports Teams
    • Governmental jurisdiction
    • Involvement of people
    • Party affiliation
    • Posters/Meetings

    ***Assessment will reveal multiple community health problems
  58. Ways the CHN diagnoses are formulated:
    • Risk of- specific problem
    • Among- community characteristics 
    • Related to- identification of specific community client
  59. Steps to the Planning process for community health nursing
    • *Requires analysis of problem
    • *Prioritize problems! criteria:
    • -community awareness
    • -motivation to resolve problem
    • -nurse's ability to influence the solution
    • -available solutions
    • -severity of adverse outcomes
    • -speed of resolution
  60. Criteria for Prioritization of Problems in community:
    • -community awareness
    • -motivation to resolve problem
    • -nurse's ability to influence the solution
    • -available solutions
    • -severity of adverse outcomes
    • -speed of resolution