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NurseFaith
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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
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A ____ community attends to and achieves the goals of Healthy People 2020
Healthy
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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
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A "community practice" setting is _____ reason for saying that practice is oriented toward the community client
- INSUFFICIENT
- 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
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Community as the client requires that _____ remains the overall goal of nursing intervention:
Improved health of the community
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Goals and Means of Community Oriented Practice
GOAL: Nurse and Community seek healthful change together
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3 Common Characteristics of Community Health:
Status, Structure, and Process
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Outcomes of Community Nursing are focused on:
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Examples of Community nursing outcomes
- Vital statistics
- Morbidity and Mortality rates
- Leading causes of death
- Mental health
- Crime rates
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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
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The structure of community health is based on:
Treatment, Services and Resources
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Examples of Structure in Community Health
- Hospitals, clinics
- Health professionals
- Government structure
- Population characteristics- demographics
- ***As socioeconomic levels increase, so does health
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As _____ levels increase, so does health in the community
Socioeconomic
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The process of community health is based on:
Competency of community in meeting members needs
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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
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Perspectives of community include:
Location, Population and Social System
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Examples of location in community:
- Community boundaries
- Location of health services
- Geographic Features
- Climate
- Flora
- Fauna
- Human-Made Environment
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Examples of things to assess in a Population in Community
- Size
- Density
- Composition
- Rate of growth/decline
- Cultural Characteristics
- Social Class
- Education level
- Mobility
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Examples of things to assess in the Social System of community:
- Variables
- Health Care Delivery System
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3 Key Steps to the Nursing process in community:
- Problem-Solving Process
- Management Process
- Process of Implementing Change
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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
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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
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Process of determining real or perceived needs of a defined community
Community needs assessment
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Types of Community Needs Assessments:
- Windshield Survey (familiarization assessment)
- Problem-Oriented Assessment
- Community Subsystem Assessment
- Comprehensive Assessment (key informants)
- Communty Assets Assessment
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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...
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Type of Community Needs Assessment: very focused on a single dimension of community
Community Subsystem Assessment
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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
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Type of Community needs assessment: focuses on strengths/weaknesses of the environment
Community Assets Assessment
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Always assess the community at different parts of the day because:
you will get different results
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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
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Primary sources of community data:
Gathered by talking to people (key informants)
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Secondary sources of community data:
records produced by people who know the community well
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International Sources of Community Data
WHO, United Nations
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National Source of Community Data
CDC, USDHHS, US Bureau of Census, NIH
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State source of community data:
Chamber of Commerce
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Local source of community data:
Libraries, Hospitals, Community Leaders
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Community Dx portray
A Community Focus
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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
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Community DX use _____ instead of a risk, goal or need statement
Community Response
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Deficit and Wellness dx of community include:
maintanence or potential change responses (due to growth and development) when no deficit is present
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Measuring or judging the effectiveness of goal/outcome attainment
Evaluating Implemented Community Health Plans
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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
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Type of Evaluation: Focus on process during actual interventions; development of performance standards
Formative
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Type of Evaluation: focus on the outcomes of interventions; effect; impact
Summative (Final)
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The Community Development Theory is based on the presumption that:
All community members participate in all aspects of change
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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
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___ is a prerequisite for effective community-oriented practice and should be a consideration throughout the process
Personal Safety
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Best guidelines for judgement of personal safety in community:
- Awareness of community
- Common Sense
- Background Information
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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
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Ways to improve personal safety in community setting:
- Call ahead
- Be organized
- Follow instincts
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A community assessment includes:
- History
- Gathering data (primary and secondary sources)
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Data collection that involved directed conversation with selected community members
Focus Groups Assessment (informant interview)
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Type of assessment when the nurse is deliberately sharing in the community life (ie: reading news paper)
Participant observation
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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
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Things to include in population/social systems assessment:
- Residents
- Demographics
- Rate of growth
- Density
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Things to include in Mobility patterns assessment:
- Private/Public transporation
- Accomodations for disabled
- Bike Lanes
- Sidewalks
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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
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Ways the CHN diagnoses are formulated:
- Risk of- specific problem
- Among- community characteristics
- Related to- identification of specific community client
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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
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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
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