Community health

nursing
BSN FINAL YEAR

BY Arzoo
COMMUNITY as Partner
Model
• Based on Neumann's model of total person
approach to viewing pt. problem,"the community
as client model"was established by authors to
illustrate the definition of public health nursing as
synthesis of public health and nursing .
• The model has been renamed as "Community as
partner"model to emphasize the underlying
philosophy of primary health care.
Model
• Two major central factors in this model are

• 1. focus on community as partner represented by

community wheel as core 2. the use of nursing
process
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• The core of the assessment wheel represents the
people that makeup the community. It includes
demographics, values, believes and history of
population.
• This model include 8 subsystems of community
Conti....
• The solid line represents its normal line of defense
or the level of health the community has reached
over time.
• The flexible line of defense, depicted as a broken
line around the community
• The 8 subsystems are divided by broken lines to
show that the are not discrete or separate but
influence one another.
Community Assessment
• As we know; A system is a whole that function
because of the interdependence of its parts.
Community too, is a whole entity that Functions
because of the interdependence of its parts or its
subsystems.
• The community assessment wheel will be your
overall framework during Community Assessment
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• The community wheel has three part
• 1. The community core
• 2. The community subsystems
• 3. Perceptions
• 1..The community core
• History
• Demographics
• Ethnicity
• Values and believes
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• 2..The community subsystems
• The physical environment
• Health and social services
• Economy
• Transportation and safety
• Politics and government
• Communication
• Education
• Recreation
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• 3..Perception
• The residents
• Your perception
Diagnosing and planning
• The community health diagnosis gives direction to
both nursing's goals and its interventions.
• The goal is derived from the stressors and may
include the eliminationof the stressors or
strengthen the community resistance through
strengthening lines of defense.
Community Analysis
• It is the study and examination of data.
• Data may be quantitative or qualitative
• Analysis of data gives information about
community health needs and community strengths.
• It also reveals gaps and incongruities in community
assessment data.
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• Steps of community Analysis
• 1.. Categorise the data
• 2..Summarize the data
• 3..Compare
• 4..Draw inference
Community owenership
• Active participation of community is essential to
achieve desired outcomes of intervention.
• The people of community need to feel a sense of
owenershipof the program or event which can only
come with their full participation in the decision
regarding plannings as well as their assuming some
responsibility for implantation.
Interventions
• Interventions are considered to be preventive in
nature
• Primary prevention is aimed to strengthening lines
of defense of community
• Secondary prevention is applied when stressor has
penetrated the community.Now interventions
support the lines of defense and resistance to
minimize the reaction's degree to stressor.
conti......
• Tertiary prevention is applied after stressor
penetrate and degree of reaction has taken place.
Evaluation
• Feedback from community provide basis for
Evaluation of community health nurse's
intervention just as involvement of community
persons in all steps of nursing process ensures
relevance to the community
• The parameters are the same for assessment and
Evaluation.
Evaluation principles
• Congruent with the theoretical foundations of working with
the community as partner, we base our program evaluation
on principles explicated by the W.K. Kellogg Foundation
(1998). These principles are summarized below.
• 1. Strengthen programs. Our goal is health promotion and
improving self- reliance of the community. Evaluation assists
in attaining this goal by providing an ongoing and systematic
process for assessing the program, its impact, and its
outcomes.
• 2. Use multiple approaches. In addition to multidisciplinary
approaches, evaluation methods may be numerous and
varied. No one, single approach is favored, but the method
chosen must be congruent with the purposes of the program.
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• 3. Design evaluation to address real issues.

Community-based and community-focused
programs, rooted in the "real" community and
based on an assessment of that community, must
design an evaluation to measure those criteria of
importance to the community
• 4. Create a participatory process. Just as the
community members were part of assessment,
analysis, planning, and implementation, so too,
they must be partners in evaluation.
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• 5. Allow for flexibility. "Evaluation approaches
must not be rigid and prescriptive, or it will be
difficult to document the incremental, complex,
and often subtle changes that occur... "(W.K.
Kellogg Foundation, 1998, P 3).
• 6. Build capacity. The process of evaluation, in
addition to measuring outcomes, should enhance
the skills, knowledge, and attitudes of those
engaged in it. This includes both professionals and
nonprofessionals alike.
The Evaluation Process
• There is a burgeoning literature on evaluation .
• Program or project evaluation has become a
specialty with whole departments and consulting
firms focused on measure- ment and evaluation.
• For our purposes (that is, to provide an
introduction to program evalua- tion), we will use a
three-part model . In this model, we look at the
process of implementing the program, the
program's impact, and the outcome of the
program.
conti.....
• Our focus in this text is on health promotion, and
health promotion programs are designed to "
influence target populations through planned
activities (process) that may have immediate effects
(impact) as well as more long-term effects
(outcomes).
Types of Evaluation
• 1 process or formative evaluation
• In this evaluation such questions are answered; Are
we doing what we said we would do?
• Did we deliver the program, provide a place to
meet?
• 2 Impact or Summative evaluation
• Is is concerned with the immediate impact of
programme on target group.
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• . If your program is aimed at changing a group's
knowledge and behavior relating to sexually
transmitted disease, for instance, you might build in
a test to find out what they learned and what their
intent is about modifying behavior. In the case of
effective-parenting classes, summative evaluation
criteria might include parental self-reports of
changes in their atti- tudes toward physical
punishment and disciplinary practices before and
fol- lowing the program, any alteration in discipline
policies at Temple Elementary, and change in the
number of reported incidences of child abuse.
conti ....
3 Outcome evaluation
however, that you find out if the changes had a
lasting and real effect. That is, did the incidence of
sexually transmitted diseases drop in this group?
Because we are getting closer to the cause-effect
question, careful evaluative research is needed to
determine the actual contribution of the program to
the outcome being measured.
COMPONENTS OF
EVALUATION
• Relevancy
• Pregress
• Cost efficiency
• Effectiveness
• Outcome
Evaluation strategies
• What sources are available for the Evaluation task?
• Is the method sensitive to the respondentsof the
program?
• How credible will your evaluation be as a result of
this method?
• What is importance of the data to be collected?ato
the overall program? To participants?
Methods For Data
collection
1 Case study
observation
Nominal group
Delphi technique
2 Surveys
3 Experimental Design
pre test post test one group discussion
pre test post test two groups discussion
Monitoring
• Monitoring measures the difference between the
program plan and what has actually happened.
Monitoring focuses on the sequence of activities of
the pro- gram, specifically, how the program is to
be implemented (the activities), by whom (the
personnel and other resources), and when (the
timing of activities).
conti...
• Monitoring is usually done with a chart, and,
although there are several differ- ent styles of
charts, all arrange activities in a sequence and
specify the time allotted to complete each task.
Monitoring charts
• To construct a monitoring chart for your program
plan, information is needed on the inputs
(resources necessary to carry out the program such
as personnel, equipment, and finances), the
process (the program activities, their sequencing,
and timing) and outputs (the expected results of
the program, including imme- diate and long-term
health effects). It is helpful to make a list of inputs,
processes, and outputs.
Usefulness to Evaluation
• A monitoring chart measures progress and can be
used to evaluate whether a program is on schedule
and within budget. Perhaps no other evaluation
method is as perfectly suited to process evaluation
as the monitoring chart. In addition, monitoring can
provide information on the cost-efficiency of the
pro- gram by measuring the average cost of the
resources required per client served.