Community Health Planning, Implementation, and Evaluation

Chapter 7
Community Health Planning,
Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Community as Client
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2
Figure 7-1
Levels of
Community Health Nursing Practice
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3
Client Example Characteristics Health
Individual Lisa McDonald Individual with various
Individual strengths,
problems, and needs
Client-nurse interaction
Family Moniz family Family system with
individual and group
Individual and family
strengths, problems, and
Interactions with
individuals and the family
Group Boy Scout
support group
Common interests,
problems, and needs
Group dynamics
Fulfillment of goals
Group member and
AIDS patients
in a given state
adolescents in
a school
Large, unorganized
group with common
interests, problems, and
Assessment of common
problems, needs, and
vital statistics
Application of nursing
process to identified
Organization A workplace
A school
Organized group in a
common location with
shared governance and
Relationship of goals,
communication, patterns
of organization to its
strengths, problems and
Consultant and/or
employee application of
nursing process to
identified needs
Community Italian
Anytown, USA
An aggregate of people
in a common location
with organized social
Analysis of systems,
problems, and needs
Community leader,
participant, and health
care provider
Health Planning Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4
Figure 7-2
Hogue (1985)
Steps in the Health Planning
 Assessment
 Meet with group leaders of aggregate to clarify mutual
 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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5
Four Types of Needs to Assess
 Expressed needs
 Demand for services and the market behavior of the targeted
 Normative needs
 Lack, deficit, or inadequacy of services determined by health
 Perceived needs
 Wants and desires expressed by audience
 Relative needs
 Gap showing health disparities between advantaged and
disadvantaged population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6
Factors for Determining Priorities
 Aggregates preferences
 Number of individuals affected by the health
 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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7
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)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8
Steps in the Health Planning Model
 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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9
Development of Goals and
 Goals—where we want to be
 Objectives—steps needed to get there
 Measurable
 Specific measures
 Instructions to guide population
 Used to measure outcomes
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10
Steps in the Health Planning Model
 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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11
Interventions by
Type of Aggregate and System Level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12
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
 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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13
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.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15
Federal Legislation Affecting Health
 Hill-Burton Act
 Regional Medical Programs (RMP)
 Partnership for Health Program (PHP)
 Certificate of Need (CON)
 National Health Planning and Resources
Development Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16
Comprehensive Health Reform
 Patient Protection and Affordable Care Act
 Preventive services based on evidence-based
 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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17
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
 Engage in aggregate-level projects
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18

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