Community Assessment Paper
OBJECTIVES:
● Compare and contrast five types of community needs assessment.
● Discuss community needs assessment methods.
● Describe four sources of community data.
● Discuss the significance of formation of community diagnoses.
The following
are the steps or phases of the nursing process.
Assessment (of patient's needs)
Diagnosis (of human response needs that nurses can deal with)
Planning (of patient's care)
Implementation (of care)
Evaluation (of the success of the implemented care)
Assessment
Assessment is the first stage of the nursing process in which the nurse
should carry out a complete and holistic nursing assessment of every patient's
needs, regardless of the reason for the encounter. Usually, an assessment
framework, based on a nursing model is used.
The purpose of this stage is to identify the patient's nursing problems.
These problems are expressed as either actual or potential. For example, a
patient who has been rendered immobile by a road traffic accident may be
assessed as having the "potential for impaired skin integrity related to
immobility".
Components of a
nursing assessment
Nursing history
Taking a nursing history prior to the physical examination allows a nurse
to establish a rapport with the patient and family. Elements of the history
include:[
* health status
* course of present illness including symptoms
* current management of illness
* past medical history including family's medical history
* social history
* perception of illness
Psychological and social examination
The psychological examination may include;
Client’s perception (why they think they have been referred/are being
assessed; what they hope to gain from the meeting)
Emotional health (mental health state, coping styles etc)
Social health (accommodation, finances, relationships, genogram,
employment status, ethnic back ground, support networks etc)
Physical health (general health, illnesses, previous history, appetite,
weight, sleep pattern, diurinal variations, alcohol,
tobacco, street drugs; list any prescribed medication with comments on
effectiveness)
Spiritual health (is religion important? If so, in what
way? What/who provides a sense of purpose?)
Intellectual health (cognitive functioning, hallucinations, delusions,
concentration, interests, hobbies etc)
Physical
examination
A nursing assessment includes a physical examination: the observation or
measurement of signs, which can be observed or measured, or symptoms such as
nausea or vertigo, which can be felt by the patient.
The techniques used may include Inspection, Palpation, Auscultation and
Percussion in addition to the "vital signs" of temperature, blood
pressure, pulse and respiratory rate, and further examination of the body
systems such as the cardiovascular or musculoskeletal systems.]
Models for data
collection
The following nursing models are conceptual models, constructed of
theories and concepts. They are used to help nurses assess, plan, and implement
patient care by providing a framework within which to work. They also help
nurses achieve uniformity and seamless care. are used
to gather the necessary and relevant information from the patient in order to
effectively deliver quality nursing care. This will help the nurse determine
the ranking of the problems encountered.
Gordon's functional health patterns
Gordon's functional health pattern is a method devised by Marjory Gordon
to be used by nurses in the nursing process to provide a more comprehensive
nursing assessment of the patient:
* Health perception and management
* Activity and exercise
* Nutrition and metabolism
* Elimination
* Sleep and rest.
* Cognition and perception
* Self-perception and self-concept
* Roles and relationships
* Coping and stress management
* Sexuality and reproduction
* Values and beliefs
1.
Case Study 1:
Asthma-related symptoms are higher in
a.
What
assessment avenues and planning strategies will you use to arrive at the
decision-making level in order to provide needed asthma-related services to
b. When the health care services in Adams and the
surrounding counties were assessed, do they appear adequate for the population?
What changes would you recommend, and how would you go about assessing the need
for change? Use information from Chapters 18 and 19.
c.
Based
on the employment data for
d. Note the top 10 employers in
e.
Many
religious resources in
f.
Are
there additional volunteer agencies and services this county needs? What
services would you add? How would you go about adding these services? Whom
would you contact and with whom would you consult? Use information from
Chapters 8 and 19.
g. What is your impression of the library services
available to the county residents? In order to get more information and other
opinions, you talk to the librarians, teachers, and some parents. They feel
there is much needed in the area of reading, reading materials, and accessibility.
What might you do as a community health nurse to help with this issue? Is this
an issue with which a CHN should become involved? Use information from Chapters
8, 9, and 19.
2. Case
Study 2: Because of the growth of Pushton as a
"bedroom community" for employees in
a. After reading the brief overview of Pushton and
View the data for
Rural/suburban
Business Directory
Top ten employers in
§
Various
small business employees (full and part-time) - 4889
§
Fordham
Leather Tannery - 1822
§
§
§
Small
business owners - 856
§
Worthmore Construction (lumber, building supplies,
manufacturing, construction) - 578
§
Hospital/health
department staff - 535
§
Community
College District employees (administration, faculty, support staff) - 344
§
County
service employees(telephone, parks and recreation, sanitation, roads) – 330
§
Family
owned farms (hiring approximately 1300 people during growing season) – 203
Census Data
500 under
1 600
1000 1-4
years 1200
1500 5-12
years 2100
1200 13-15
years 1600
1700 16-19
years 2100
2500 20-25
years 3000
4100 25-35
years 4400
7800 36-50
years 10,000
7100 51-65
years 9000
3200 66+
years 6000
County racial composition:
White 48,000
Hispanic 12,000
Black 5000
Asian 4000
Native
American 1000
Educational level of
residents over 18:
less than 8 years of school
10%
some high school 22%
completed high school
29%
some college/tech training
13%
completed 4 years college
20%
more than 4 years of college
6%
*
*
*
Incorporated
Towns in
Chamber of Commerce description: This city is
nestled in the foothills of the
Pushton - pop. 8,000:
Chamber of Commerce description: This is a
"bedroom community" for the nearby city of
Pullton - pop. 6,000:
Chamber of Commerce description: Pullton
is the third largest town in
Chamber of Commerce description: Preston is the
fourth largest town in
Chamber of Commerce description: This small town is
located in the northeastern corner of
Weston - pop. 2,500:
Chamber of Commerce description: This small town is
located in the western part of the county. It provides needed services to the
neighboring agricultural areas of Adams and
Educational/Library Resources
All schools in this
county are full inclusion - students of all academic and physical abilities
attend classes together. If special attention is needed, the student is pulled
out of class for one or two subjects taught in small groups with other students
who need special attention, or in some situations a teen may attend the
alternative high school.
One city high school in
Newtown High School -
grades 9-12, 2200 students, 6 counselors, 1 psychologist, 1 school nurse;
offers 12 different sports and has 23 clubs. Ninety percent of the students graduate
and 65% of the students go on to college. Thirty percent of the teachers have a
master's degree. Four foreign languages are taught: German, French, Spanish,
and Latin. The school is well known statewide for its athletic programs.
Three regional high
schools located in Pushton,
Each regional high school
is located near one of the three towns in the county. They are similar is size,
with 1000-1200 students. They each offer 6 different sports and each has 12
clubs. Eighty-two percent of the students graduate at Central High near
Three middle schools -
grades 6-8 - in
There is one counselor in
each school, and two school nurses split their services among the three
schools.
Eight elementary schools
- grades 1-8 - three in
Two counselors and two
school nurses provide services to the eight schools. Each school has a
parent-teachers association. Those in central
One community college
with two satellite centers:
One alternative high
school program:
Located in Newtown,
busing teens from all over the county, mainly from Pushton
and Easton. Students from
Weston, Pullton, and
One home schooling
center:
In
One county library in
The library is in a
two-story building with 500,000 holdings. It has Internet access and supports
two mobile libraries. The two mobile libraries are staffed by a librarian and
volunteers arrive two days a week in each of the 5 towns and villages. They are
equipped with a computer for Internet searches. Plans are being made to make
one available on Saturdays to the retirees at the
Health Care
Adams County Health
Department: A small comprehensive health department with five community health
nurses, one LPN/LVN, one medical director, two laboratory technicians, one
health educator, one mental health specialist, one statistician, and three
support staff.
A health maintenance
clinic operates out of the
Nine physicians: two
planning to retire within three years, five in general practice, two in OB/GYN,
one pediatrician, one surgeon. All have privileges in hospitals in the four
counties.
Three dentists: one
retiring in two years
Home health is provided
through two private agencies located in
Services in Neighboring Counties
A satellite health
department as a part of a regional health department located in Center County
north of Brown County where the state capitol is and the bulk of the state's
population. The health department is staffed with 1 community health nurse, one
LPN/LVN, a part-time medical director, health educator, and mental health
specialist, and two support staff.
A surgi-center
for elective surgeries in
Two physicians, one just
in obstetrics
Two dentists, one dental
clinic staffed by student dentists from the state university in
Three midwives in private
practice
Home health services are
provided by one private agency in
A small comprehensive
health department with 7 community health nurses, 2 LPN/LVNs, 1 medical
director, 2 laboratory technicians, 1 health educator, 2 mental health
specialists, 1 statistician, and 5 support staff
A community hospital in
Corner Groves with 140 beds,;20 are for maternity
clients and newborns, has a new children's wing with a NBICU and PICU
Home health is provided
through a proprietary home health agency of the hospital in Corner Groves
serving
10 physicians, 2 planning
to retire within 3 years, 6 involved in general practice, 2 specializing in
GYN/OB, 1 orthopedic surgeon, 1 pediatrician
A small comprehensive
health department - 4 community health nurses, 1 medical director, 1 laboratory
technician, 1 health educator, 1 mental health specialist, 1 statitician, and 3 support staff
A community hospital in
Seven physicians and two
nurse practitioners, no retirements planned within the next three years, all in
general practice with two focusing on gerontology
Four dentists
One chiropractor
Seventy-two beds for
assisted living/skilled nursing for older adults; 1 facility with 36 beds and 6
board and care homes, each housing 6 elders
Home health services are
provided through the proprietary agency of the hospital in
Legal System
County government:
County commissioner
(4-year term)
Oversee all utility,
road, and parks and recreations services in the county
City and township
governments:
Elected mayor and
city council in Pushton, Pullton,
and Preston (6 members rotating service for 2 years each term). The mayor and city councils make decisions
regarding city safety, growth, and other matters brought to the city by
residents. They preside at holiday occasions and store openings and promote
town attributes through the chamber of commerce
Honorary mayors in
Media
and Communication Services
Newspapers:
§ One daily and Sunday (circulation 7500) that
contains world, national, and regional news and syndicated columns and
features.
§ One Monday-Wednesday-Friday (circulation 2600) that
focuses on regional and local news, store advertisements. Offers free notices
of meetings and events sponsored by nonprofit organizations.
Pushton, Pullton, and
§ Residents subscribe to the daily
§ Each town has a weekly publication with local news
and advertising- distributed free to each town's postal addresses
Radio stations:
Two located in
Television stations:
*
None
in
*
Cable
or satellite TV is available in
Publishers:
Redhorn Press is located in
Religious Resources
Twenty-six
houses of worship are listed in
Ninteen Protestant denominations:
Nine
in
*
*
* Redeemer Christian Church has three services on
Sunday and one on Wednesday evening. It has a preschool program and a large
youth ministry.
*
* The
* The four other protestant churches are small and
have services on Sunday. Each minister has access to funds/resources to help
families in need - primarily members of that church.
Three
in Pushton:
*
* The other two smaller churches hold one service on
Sunday and have part-time ministry staff.
Two
in Pullton:
* Valley Christian Church - has two services on
Sunday, a day-care program and offers a meeting room for nonprofit groups to
meet.
*
Two
in
*
* Trinity Christian Church - one service on Sunday and
has an active youth program.
One
in Weston:
* Weston Christian Church - one service on Sunday and
a late evening (9 PM) service on Sunday night for farm workers to attend. It
has many community services using the meeting room during the week - AA, NA,
GA, PWP (Parents Without Partners).
Two
in
*
Five
Catholic churches:
Three
in
* St.Andrew's is the largest Catholic church
- it has five services on Sunday and two on Saturday. Has
Bingo on Thursday night, frequent fundraisers, and an active ministry serving
families in need in the community.
* Our Lady of Hope has three services on Sunday and
has a craft store - profits go to missions.
* St. Luke's has two services on Sunday and one on
Friday. It offers a meeting room for nonprofit groups to meet.
One
in Pushton:
* St. Mary's is a large church with many young
families attending. It offers five services on Sunday, a preschool and a day
care program, a "food and clothing" bank, several rooms for community
groups to meet and a Father's Club - for the men in the church.
One
in Pullton:
* St. Benedict's offers three services on Sunday. It
has Bingo on Tuesday evenings and offers a "hot meal program" to
seniors on a donation basis.
One
Budhist temple:
* Located in Weston, it is a new and small temple,
attended primarily by the county's Asian population - mostly living in the
rural, farming Weston area. The temple is attended by two nuns. They can
arrange temporary food and shelter for work in the temple or on the grounds if
needed by anyone.
One
Synagogue:
* Located in
Recreational and Entertainment Resources
Community
Recreational Services:
YM/WCA
- located in
Country
Clubs:
Pushton Country Club - open membership to anyone who pays
the fees. Offers an outdoor swimming pool, 18-hole golf
course, tennis courts, restaurant and lounge.
Gardens:
Golf
- public courses:
Pushton Mini-golf - three 18-hole miniature golf courses
with three different themes - popular with families. Has a video game room and
a snack bar.
Parks:
Theaters (live):
Newtown Community College
Theater - sponsors plays 4 times a year performed by community college students
at reasonable prices.
Theaters (movie):
Newtown Cinema - 4
theaters playing the latest movies. Afternoon and senior discounts.
Pushton Theater - 3 theaters playing the latest movies. Afternoon and senior discounts.
Preston Theater - 1
theater playing the latest movies. Afternoon and senior discounts.
Safety
- Fire and Police Protection
*
* Pushton,
* Weston and
* The county highway system is patrolled by county
police officers.
* State troopers serve the Weston area as part of
their services along Interstate 44.
Visitor's
Bureau
*
*
Volunteer Agencies and Services
American
Cancer Society - has its county headquarters in
Website
- www.cancer.org
American
Lung Association - has an office in
Website
- www.lungusa.org
Hospital
Auxiliary - volunteers (predominantly seniors and teens) work in
March
of Dimes - has its office in
Website
- www.modimes.org
4H
Club and FFA (Future Farmers of America) - The two regional high schools in Pullton and
Scouting
- Girl and Boy Scout troops. Area Council headquarters in
Service
clubs - Lions, Rotary, VFW, Elks and Moose Lodges. All have meeting halls in
Senior
Centers - the county has 5 senior centers. Two are located in
Social Welfare System
The
county social services department is in
Services
include:
* Children and Adult Services - social services for
children and adults who are being abused or neglected. Through these services
children are placed in foster care and families receive counseling. This agency
works closely with the police and judicial systems. Older adults who are
neglected and/or abused are served through the AAA (Area Agency on Aging) located
within these services.
* Employment
* Income Maintenance - temporary financial help is
available to women and families with dependent children. This federal and state
program can offer financial assistance while parents received the training
and/or education needed to support their children for up to five years.
* Social Security Office - any person eligible for
Social Security benefits or those wanting to inquire about benefits can receive
information and/or begin the necessary paperwork. People generally eligible for
Social Security benefits are the permanently disabled, aged, widowed and the
dependent children of those adults.
* WIC (Women, Infants, and Children) Program - this
federal program provides healthy foods to children up to five years of age and
pregnant and lactating women who are income eligible. Self and professional
referrals are accepted.
1.
Allender, J. A., Spradley, B.W. (2001). Community
Health Nursing: Concepts and Practice (5th edition). Lippincott Williams & Wilkins; 5th edition (January
15, 2001). 799 pages. ISBN-13: 978-0781721226. Chapters 8,
9, 17-21.
2.
Stanhope, M., & Lancaster, J. (2000).
Community and Public Health Nursing (5th Edition)
3.
Stanhope, M., & Lancaster, J. (2006).
Foundations of Nursing in the Community: Community-Oriented Practice (2nd
Edition)
4.
Allender, J. A., Spradley, B.W. (2004). Community Health Nursing: Promoting and Protecting the Public's Health (6th
Edition) Lippincott Williams & Wilkins, 2004. – 992 p.
Selected
1. Brink, S. (2002). Living on the edge. U. S. News & World Report,
133(14), 58–64.
2.
Center for Medicare and Medicaid Services.
(2002). Retrieved October 3, 2003, from http://www.cms.gov
3. Conger, M.M. (1999). Managed care: Practice strategies for nursing.