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
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
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.
Prepared by
Nataliya Haliyash,
MD, BSN
18/08/2009