Community Health Planning, Implementation and Evaluation

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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

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Figure 7-1

Levels of Community Health Nursing Practice

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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

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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

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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

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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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

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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)

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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

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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

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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

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Interventions by Type of Aggregate and System Level

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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

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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.

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PRECEDE-PROCEED Model

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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

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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

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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

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