NSG 440 Exam 2 - Topic 5

Okay, good morning, good afternoon, good evening, whenever you're listening to this. I am Dr. Mueller, and I am recording a review of topic five, which is chapter 12 in your textbook, and this is community assessment and evaluation. The objectives for this topic are to look at the interventions when we talk about health promotion and disease prevention. based on community assessment data and then applying the planning and evaluation framework so that we can do those health promotion interventions. Okay, so a one-minute paper. Have it, you can, since you're listening to this rather than in live form, think of what your idea of a community is. Maybe jot a few things down. You can pause. this if you want. I know no one will. But anyway, think about what you think of when you hear the word community. Overall, your book talks about a healthy community is one where residents are happy with their choice of location and the exhibit characteristics that would draw others to location. Sometimes I think of like little community ads where they want people to come live in their new community or whatever it may be. So we're looking at, in this topic, the community as a client. In population health, often we look at the community as our client or our individual. The community is the group of individuals, and that becomes our client or our patient or however you want to view that. So when we look at exactly what a community is, often I think of Punxsutawney, Pennsylvania with Groundhog Day because that's a distinct community. There was also a program called Community and that was about a group of community college students. And ironically, that's when I was working for a community college. But anyway, a community is whatever that is that you're examining. So when we talk about a community as far as the simplest form, it's a group of people who share something in common, such as a geographic location like Punxsutawney, Pennsylvania, or an interest or a value. So you as nursing students in level four are a community of GCU nursing students who are getting set to graduate. There is a more detailed definition from the WHO, from the World Health Organization. I'm not going to get into that too much. But we need to be very clear about what the community is. And so when we assess the data related to from the inside to the outside of the community or the outside to the inside, we need clear knowledge of that community. Who, what, where that we are looking at. So when we talk about people in a community, it could be the residents of a community. It could be a group of students like you. all of you. It could be the members of an organization. It could be, it's all different things. And so then we look at the place and that may be geographical. It may have time dimensions, such as Grand Canyon University nursing student, and that you as level fours, eventually that you will no longer be a level. for nursing students. You will graduate, you will take boards, you will become a member of the community or the organization that you work for. And that transcends this community that you are currently in. And we also look at the function. What are the aims and activities of that community? Okay. I'm just going to touch on some ethical concepts with... a community's health, when we're examining that community as a client. Utilitarianism, I believe we've talked about before, it's doing good for the greatest number of people. When we wore masks, there was mandatory masking, social distancing. That was, overall, we were doing that because it helped the greater good. Overall, The majority of people could benefit from that because we weren't sharing our dreams. Distributive justice. That can be looked at as equal opportunity, but also equal burden. When we talk about distributive justice, it's fairness or doing a fair share. Hopefully, we have a fairness of the opportunity and burden with taxes. That is up for debate because, as we know, not everybody pays their fair share when we look at tax breaks for the wealthy. But that is a topic. for a different day, a different place. Military service, equal opportunity, but also equal burden that people have the equal opportunity to enroll, but also we support military service. Now, social justice is a step further than distributed justice. It's a little more broad. We look at those social determinants of... health. And we look at equal, equitable resource distribution for vulnerable groups. So think of our, I think the book might have used elderly or older generation is the more politically correct term. And because they are somewhat more vulnerable, we do have a social security plan for them. And we have Medicare to help cover healthcare expenses. When we look at vaccines, we have a vaccines for children program so that all children within the United States can be vaccinated and there's equal resource distribution. So sometimes when we're looking, doing a community assessment, we may look at disparities based on the data. For instance, if there's a disparity. of mortality and morbidity among certain racial groups. For instance, I just moved from Missouri. If you are a non-white woman who is pregnant or giving birth in the state of Missouri, it has a significantly higher rate of mortality and morbidity for non-white women who are pregnant or giving birth. So social justice would look at that and say, that is a problem. problem that should be given higher priority. When you do your community assessment and you have all these priorities that you've identified that this is a problem, this is something that the community needs to, you know, needs a resource for, something like that may be, when we talk about social justice, that may be put to a higher level than, say, getting a park in this community or something like that. So hopefully that makes sense. Okay, so the community as a client, that is us looking at the health of the community. And that remains your overall goal for nursing interventions. When you're in public health nursing, your overall goal when you're looking at the community as a client is what you can do within your scope of practice as a public health nurse for that community. And we look at commitment to two key concepts. community health, we want healthy communities, and also partnership with those communities. So while we may have some ideas based on our assessment about what that community might need as far as becoming more healthy, that has a lot more aspects and more partnership, which I'm going to talk about here in just a minute, on making sure that it's not just this health department coming in and saying, we've acquired this county as part of our five-county area, and we see that you have problems with X, Y, and Z. So this is what we're going to do for your community. Is that a good plan? Probably not, because you haven't truly done an assessment and done some partnerships with people in that community to identify. if that's even feasible, if it's something that they even see as a problem. When we say goals and means, it's doing health for change for the whole community's benefit. So it may be this community has no access to safe places to exercise. Maybe you're looking at a... highly populated community, maybe there's crime, and they need some safe places like an indoor walking and running track or something like that. So it's looking at things that may benefit the whole community. Okay, again, Healthy People 2030, do we mention it every single topic? Yes, pretty much. So they've recognized the need to work collectively in a community partnership, so that changes will be necessary through that partnership so that it's a shared vision. It's not just public health saying, here's what we think you need. And it's not just the community saying, no, we need this. And so it's a group effort coming together and having that collaborative partnership, whether it's attaining a goal with healthy people is attaining healthy, thriving lives and well-being. So we want them free of preventable disease, disability, injury, and premature death, which means possibly some healthy programs, giving vaccinations, things like that, things that can be addressed. to help people have healthy, thriving lives. Eliminating those disparities, like we talked about before. Achieving health equity means that everyone has equal access to health care and being healthy. And we also try to attain health literacy, meaning we try to educate everybody on what they can do to improve their health and well-being. They're maybe creating social, physical, and economic environments that have that potential for improving health and well-being, promoting healthy development, such as healthy behaviors and well-being across all the life stages, whether we're starting at infancy through grade school, middle, high school, adults, middle-aged, elderly, all of those. We want a healthy, long- life and well-being, and then engaging leadership, reaching and partnering with those key people in communities to take action and design policies together that improve the health and well-being of all. So when we have those partnerships, we want to make sure we have community members involved, and those community members really should reflect the community at large. So if you're getting partners for your health. department board and you it's the community is 60 percent um english as a second language people then that is how your board should be reflected the members of your board should be 60 percent made up of people who have english as a second language or whatever that may be so we look at coalitions and those are more formal partnerships um a steering committee advisory committees work groups It's active partnerships between population health, public health, and the participants within that group. Just like I mentioned the health department board, that would be a coalition, a formal partnership. We do sometimes see a passive participation, which is a negative nurse community partnership. So You're doing your data assessment and you're only talking to them just to get information. And then you say, OK, this is what I've gathered. Here's what should happen. We need a positive approach that has those people actively involved and sharing in the assessment planning and implementation of community changes. And then our role again, we need to establish credibility and trust in the community. If you're from that community, that may not be too difficult. If you're not, if you don't know that community very well, you may need what's called a gatekeeper, which sounds much more formal than it is. Or sometimes I think of Keymaster, Ghostbusters. Anyway, gatekeeper refers to formal or informal community leaders who create the opportunities, have the nurse get. introduced to the community, maybe like clergy might say, well, you should come to our Wednesday night board meeting and talk about things that are possible for the community and get feedback or come to this kids fair we're going to have and meet some of the parents in the community or whatever it may be. So it's important to be integrated into the community. All right. So. why is community assessment important and why is it important to include members of the community not in that passive participation but active participation well i'm going to tell you a little story because i mentioned if the community doesn't see something as a need or a problem your program or actions that you're doing won't be effective or helpful they won't even go to whatever you're setting up so I'm going to give you a little story here. And I do have in the speaker notes, a link to, I got him from LinkedIn, actually looking at different programs that were epic fails. And there, I just found them fascinating because overall we've seen that happen when governments decide the government decides, Oh, we need a program for this. Then we need to do this. Then we need to spend this many trillion dollars on this. And then they don't ask the people who will be affected by it. And it's a failure. So anyway, long story short, sort of, it's called the Turkana Fish Factory in Kenya. The Norwegian government came into this area. It was called Lake Turkana. And they looked at a fish freezing, doing a fish freezing factory in this village. They saw that the lake was full of fish and they weren't being utilized by the local people. It was a very impoverished area. It had few economic opportunities for the local farmers. They were mostly poor. And so the Norwegian government thought it didn't sound like a bad idea to just re-educate and train the local people to capture and process fish from this lake that's overflowing with fish that weren't being utilized. So... They spent $150 million and built this factory and developed it and then had to abandon it. So why did it fail? Well, the people in that area, and I did pull this. I hope this is actually, it said it was from the Turkana fish freezing factory. The people in that area, those local people, they did not eat fish. They believed that the... only the most desperate people should fish. I don't know exactly what they said, local farmers. I'm not sure exactly what they did. It looks like maybe there's some crops in the area in the background. I don't know. But it's a perfect example of not talking to the people who will be affected by what is happening. The Norwegian government would probably have been much better off taking that $150 million, not to mention the time and energy. they spent invested in the local infrastructure and build up businesses that so they could operate better things that already exist rather than the fish freezing factory so anyway until i was researching this little lecture here i didn't even know about so i um there are four other well-intentioned initiatives that went horribly wrong um if you're interested in reading so um It's important to learn about the community needs and their strengths. So there were local farmers. There were some businesses. What could they do to possibly work smarter, not harder, and use the things that were there? So when we do data collection, we have two main sources. We have primary data and secondary data that I want you to be very clear on. So when we talk about primary data, that is direct. through interaction with the community members. It may be community leaders. It may be people just within the community. You may do participant observation. Go to the county health fair or the county fair. Go to events in the community. Go watch what happens on Saturday mornings. Is there a park? What's going on? And that's some observation where you're one-on-one directly observing collective. death. There may be a deliberate, again, sharing of life, attending some event. You might do key informant interviews. You might just do a person, you know, be in the downtown and people walking by. Hey, can I talk to you about your community? Or it could be formal where you pull in specific people, you invite them or on Sunday or let's say Saturday morning, anybody who wants to come and talk about the community, come talk about the. the community. You may do surveys. So we're going to talk a little bit more about windshield surveys in a second here. Town hall meetings. You may attend a town hall meeting, which is open to the public, and talk about what you're there for and how you want to gather data. You may do specific focus groups, maybe moms of preschoolers and what resources do they have. You might do a focus group of them. Or. high schoolers or young adults who don't currently have jobs or something like that. Just you're gathering direct interaction data. Secondary data is obtained through existing reports on the community. This is again, work smarter, not harder. If there is information out there, you should be pulling it. Look at surveys that have already been completed. Maybe they've surveyed the community before. Maybe a lot of high schools do behavioral risk surveys of their teens at certain grades, like all 10th graders or 9th graders or whatever, on behavioral risks, drug and alcohol use, tobacco use, self-harming behaviors, suicide, risk and depression. Those surveys are, if they're out there, pull that data. CDC has great data on social determinants of health. There's... vital statistics data out there. The average income, average housing prices, the births, the mortality and morbidity rates, the levels of infectious disease, immunization, dental, there's all sorts of data. Secondary data is wonderful. I'm a researcher. That's what I love, secondary data. And then also advocacy organizations. There may be social services that has information on homelessness, child abuse. direct domestic violence, all of those things. So we do data collection as part of our community assessment. We gather all that data. I do want to mention too, well, here, I'll talk about it here. So when we talk about community assessments, I want to talk about windshield surveys because they can be the first step in the process of getting data that identify a lot of information about the community without having to do a lot of... primary like interviewing. It's very simple and inexpensive. If you are on time constraints or a limited budget, windshield surveys are always a good, simple, inexpensive way to gather information. So it's involving going out into the community, taking pictures, taking notes. Usually there's like a, not a script, but like a tool that you use on where all you look. You look at boundaries of the community. What is the typical employment? Are there factories? Do people have more white-collar jobs, blue-collar jobs? What is the housing like? What's low-income housing like? Is there enough housing in general? What is the transportation? If someone doesn't have an automobile, are they still able to get where they need to go? Is it a rural community? Is it an urban community or a larger community? What kind of services are available? Are there physicians that are available? Or is it a small rural community and a physician from a larger area comes in once a week to see people and a dentist comes in once a month? Or what does all that look like? And so why normally we do both in the morning and the evening, maybe on a day. a weekday and a weekend we're gathering data why do you think we would do both morning and evening when we're doing community assessment we i'll say pause the thing okay we want to look at that view of residents what that community looks like during the day when people are working and also in the evening when they're at home what do what do the um you What do the people do in the evening? Are they going for walks? Is there a place to go for a walk? What does the housing look like? Is there peeling paint? Are kids getting to school on a bus during the morning or are they walking home after school? Is there a place for them to play? I did put a picture here because this is a more current updated playground. Is it a rural community and this is all they have? Or is it an area where maybe... taxes are they don't get as many taxes and so they don't do upgrades to areas like playgrounds and this slide is the any gen x or and some millennials even that was the slide of death because it was like 10 million stories high there was no little seat at the top there's just the top step and then you have to balance on there and go down if you had any sort of you skin showing it burned if it was over 80 degrees. If you had rubber shoes, you kind of stuck and almost fell over the side. And this shows like sand or wood chips. Normally, it was in some compacted dirt here and you biffed it at the bottom and it was very unsafe. So long story short, you observe all of these type of things. You may look at churches. Are there a lot of churches? Are there few churches? If it's a Wednesday evening, are there lots of people there? And then you're looking at what kind of nursing diagnosis you might start to identify here. The book talks about some others. CDC has a tool called CASPER. There's some other map change. Don't get too in the weeds on that. I just have it included there just because those might be some other options that... health department or a public health nurse might utilize. Okay, so let's talk about community diagnosis. It looks a little bit different because, again, the community is our client, not someone, you know, one-on-one bedside nursing. So we still do that ADPAI, the assess, diagnose, plan, implement, evaluate. But as we identify a problem, it's a little bigger. It may be an actual problem. problem or it could be a risk of a problem. So we might look at the increased number of clients in this community that are diagnosed with type 2 diabetes. And it may be related to inadequate access to the ability to exercise, walking trails, parks, and numerous fast food restaurants, and few primary care providers in the community. This is just an example here. And then you may say it. evidenced by, from your secondary data, 200 new cases of type 2 diabetes in 12 months, and the age ranges and the percentage of female and male and the number of primary care providers for that population. And so your outcome might be to look at, you'd want a decrease in new cases, 20% decrease in new cases, 12 months after initiating. preventative community diabetic education program and awareness campaign. Maybe you can hit those people who are borderline type two and reverse it and then have that many less new cases. So the community diagnosis then is what will drive the planning. So you'll take, which we're going to talk about in the next slide here, but you're going to take all these things that you've identified as problems and possible, put them into your whole ADPAI thing. And then you're going to prioritize them. Another example could be risk of cardiovascular disease among people in this county due to lack of XYZ. So hopefully that makes sense. So we apply that nursing process. This is just kind of restating here. We define the community. What is it? what is that group we want to look at? And then we collect the data. We do the data. And then we analyze it so that we can identify those problems and rank them, prioritize those problems. And then we create those. Once we have those nursing diagnosis and we've prioritized them, then we'll look at the planning, implementation, and evaluation. We're going to talk about this in much greater detail in... future topics. So I'm not going to get too in the weeds on it. But I do want to talk real quick here about the evaluation piece. Because as you're doing your planning, you need to somewhat identify the type of evaluation that you may do depending on the plan. So and you know, you may have 10 different plans depending on, you know, 10 different not 10 is pretty broad. Let's say you may have three problems that you've identified that you're going to try to. create a plan for. And depending on what that plan is, you'll need to evaluate it because that's the last piece of our ad pie. And so two main types of evaluation are formative and summative. Be familiar with those. Formative, I use the thesaurus of PowerPoint to find some other words. So it's shaping like taking when you think of a piece of clay and you shape it, then you can step back and look at it and say, you know what, that doesn't look right. That ear, that ear should be on the forehead rather than the chin or whatever. I don't know. But you're shaping. So you're doing that with the program. And what you do is you have at midway or at some pulse point throughout the program. program, you do a kind of a pulse check on how this program is going. You may survey the participants and say, hey, we're meeting weekly. Is that something that works well for you? We're meeting, and they may say, weekly is fine, but this is what you weigh us every week. I'm just making this up on, say, it's a weight management plan. So they say, we meet. every Monday and you weigh it. And we struggle on the weekends with following this program. We would prefer that we weigh every Friday. And so, I mean, that's something you could change and then apply that to the rest of the program throughout the length of the program. Summative is just what it sounds like. Summary, you do it at the end of the program and it may be at the as soon as the program's over, you survey the participants. It could be, and it's not just participants, it could be maybe, again, how we talked about decreasing the incidence of type 2 diabetes. Your summative evaluation could be a year after it, what do the details look like as far as new cases or whatever it may be. So you need to, and you may do both formative and summative. But you have to include that in your planning that, hey, halfway through, here's this survey we will be giving them. Or, hey, at the end, this is how we'll know what changes we need to do the next time we do this. So hopefully that makes sense. Okay. So, as always, we always talk about levels of prevention, right? LOPs. And really, this one, when I put this together, it's very similar to what we've talked about before. for, but we always look at it. So when we're talking about the community as the client, how does that look? Well, primary, it may be giving vaccines for the community. Maybe it's a community that's in a floodplain and sometimes they flood. Primary prevention of tetanus, because they're at risk of being in a flood, is you would give tetanus vaccines for that community. Primary prevention. You don't want that community to get tetanus because they're in floodwaters or whatever. Secondary screening for hypertension. It's a community with a high risk of cardiovascular disease, high incidence. Or it may be that community where we were talking about high numbers of type 2 diabetes every year. So you might do go to a community event and do. checks of blood glucose or draw hemoglobin A1Cs or whatever it may be, or tertiary, maybe you do take that group, that community that has those high incidences of type 2 diabetes, and you do some sort of class that talks about methods to bring down your hemoglobin A1C, maintain your diabetes. with oral hypoglycemics or what you know all those type of things would be tertiary because the problem is already there and you're trying to keep it from worsening or improve you want it to improve that hopefully that summarizes okay primary prevention ppp secondary screening tertiary teaching education it won't always be quite so you cut and dried when we talk about levels of prevention. But again, this week it is. So hopefully that didn't take too long. And again, if you have any questions. Do I say things that are different from the book? Probably often. So if something doesn't sound right, you read some information and it's different than what I talked about, always ask because I am human and I make errors. So thank you for hanging with me and I will talk to you again a different week.

Have it, you can, since you're listening to this rather than in live form, think of what your idea of a community is. Maybe jot a few things down. You can pause.

this if you want. I know no one will. But anyway, think about what you think of when you hear the word community. Overall, your book talks about a healthy community is one where residents are happy with their choice of location and the exhibit characteristics that would draw others to location.

Sometimes I think of like little community ads where they want people to come live in their new community or whatever it may be. So we're looking at, in this topic, the community as a client. In population health, often we look at the community as our client or our individual. The community is the group of individuals, and that becomes our client or our patient or however you want to view that.

So when we look at exactly what a community is, often I think of Punxsutawney, Pennsylvania with Groundhog Day because that's a distinct community. There was also a program called Community and that was about a group of community college students. And ironically, that's when I was working for a community college.

But anyway, a community is whatever that is that you're examining. So when we talk about a community as far as the simplest form, it's a group of people who share something in common, such as a geographic location like Punxsutawney, Pennsylvania, or an interest or a value. So you as nursing students in level four are a community of GCU nursing students who are getting set to graduate. There is a more detailed definition from the WHO, from the World Health Organization.

I'm not going to get into that too much. But we need to be very clear about what the community is. And so when we assess the data related to from the inside to the outside of the community or the outside to the inside, we need clear knowledge of that community.

Who, what, where that we are looking at. So when we talk about people in a community, it could be the residents of a community. It could be a group of students like you.

all of you. It could be the members of an organization. It could be, it's all different things. And so then we look at the place and that may be geographical.

It may have time dimensions, such as Grand Canyon University nursing student, and that you as level fours, eventually that you will no longer be a level. for nursing students. You will graduate, you will take boards, you will become a member of the community or the organization that you work for. And that transcends this community that you are currently in. And we also look at the function.

What are the aims and activities of that community? Okay. I'm just going to touch on some ethical concepts with...

a community's health, when we're examining that community as a client. Utilitarianism, I believe we've talked about before, it's doing good for the greatest number of people. When we wore masks, there was mandatory masking, social distancing.

That was, overall, we were doing that because it helped the greater good. Overall, The majority of people could benefit from that because we weren't sharing our dreams. Distributive justice. That can be looked at as equal opportunity, but also equal burden. When we talk about distributive justice, it's fairness or doing a fair share.

Hopefully, we have a fairness of the opportunity and burden with taxes. That is up for debate because, as we know, not everybody pays their fair share when we look at tax breaks for the wealthy. But that is a topic.

for a different day, a different place. Military service, equal opportunity, but also equal burden that people have the equal opportunity to enroll, but also we support military service. Now, social justice is a step further than distributed justice.

It's a little more broad. We look at those social determinants of... health. And we look at equal, equitable resource distribution for vulnerable groups.

So think of our, I think the book might have used elderly or older generation is the more politically correct term. And because they are somewhat more vulnerable, we do have a social security plan for them. And we have Medicare to help cover healthcare expenses.

When we look at vaccines, we have a vaccines for children program so that all children within the United States can be vaccinated and there's equal resource distribution. So sometimes when we're looking, doing a community assessment, we may look at disparities based on the data. For instance, if there's a disparity.

of mortality and morbidity among certain racial groups. For instance, I just moved from Missouri. If you are a non-white woman who is pregnant or giving birth in the state of Missouri, it has a significantly higher rate of mortality and morbidity for non-white women who are pregnant or giving birth.

So social justice would look at that and say, that is a problem. problem that should be given higher priority. When you do your community assessment and you have all these priorities that you've identified that this is a problem, this is something that the community needs to, you know, needs a resource for, something like that may be, when we talk about social justice, that may be put to a higher level than, say, getting a park in this community or something like that. So hopefully that makes sense. Okay, so the community as a client, that is us looking at the health of the community.

And that remains your overall goal for nursing interventions. When you're in public health nursing, your overall goal when you're looking at the community as a client is what you can do within your scope of practice as a public health nurse for that community. And we look at commitment to two key concepts. community health, we want healthy communities, and also partnership with those communities. So while we may have some ideas based on our assessment about what that community might need as far as becoming more healthy, that has a lot more aspects and more partnership, which I'm going to talk about here in just a minute, on making sure that it's not just this health department coming in and saying, we've acquired this county as part of our five-county area, and we see that you have problems with X, Y, and Z.

So this is what we're going to do for your community. Is that a good plan? Probably not, because you haven't truly done an assessment and done some partnerships with people in that community to identify.

if that's even feasible, if it's something that they even see as a problem. When we say goals and means, it's doing health for change for the whole community's benefit. So it may be this community has no access to safe places to exercise.

Maybe you're looking at a... highly populated community, maybe there's crime, and they need some safe places like an indoor walking and running track or something like that. So it's looking at things that may benefit the whole community. Okay, again, Healthy People 2030, do we mention it every single topic?

Yes, pretty much. So they've recognized the need to work collectively in a community partnership, so that changes will be necessary through that partnership so that it's a shared vision. It's not just public health saying, here's what we think you need. And it's not just the community saying, no, we need this.

And so it's a group effort coming together and having that collaborative partnership, whether it's attaining a goal with healthy people is attaining healthy, thriving lives and well-being. So we want them free of preventable disease, disability, injury, and premature death, which means possibly some healthy programs, giving vaccinations, things like that, things that can be addressed. to help people have healthy, thriving lives.

Eliminating those disparities, like we talked about before. Achieving health equity means that everyone has equal access to health care and being healthy. And we also try to attain health literacy, meaning we try to educate everybody on what they can do to improve their health and well-being. They're maybe creating social, physical, and economic environments that have that potential for improving health and well-being, promoting healthy development, such as healthy behaviors and well-being across all the life stages, whether we're starting at infancy through grade school, middle, high school, adults, middle-aged, elderly, all of those. We want a healthy, long- life and well-being, and then engaging leadership, reaching and partnering with those key people in communities to take action and design policies together that improve the health and well-being of all.

So when we have those partnerships, we want to make sure we have community members involved, and those community members really should reflect the community at large. So if you're getting partners for your health. department board and you it's the community is 60 percent um english as a second language people then that is how your board should be reflected the members of your board should be 60 percent made up of people who have english as a second language or whatever that may be so we look at coalitions and those are more formal partnerships um a steering committee advisory committees work groups It's active partnerships between population health, public health, and the participants within that group.

Just like I mentioned the health department board, that would be a coalition, a formal partnership. We do sometimes see a passive participation, which is a negative nurse community partnership. So You're doing your data assessment and you're only talking to them just to get information.

And then you say, OK, this is what I've gathered. Here's what should happen. We need a positive approach that has those people actively involved and sharing in the assessment planning and implementation of community changes. And then our role again, we need to establish credibility and trust in the community. If you're from that community, that may not be too difficult.

If you're not, if you don't know that community very well, you may need what's called a gatekeeper, which sounds much more formal than it is. Or sometimes I think of Keymaster, Ghostbusters. Anyway, gatekeeper refers to formal or informal community leaders who create the opportunities, have the nurse get.

introduced to the community, maybe like clergy might say, well, you should come to our Wednesday night board meeting and talk about things that are possible for the community and get feedback or come to this kids fair we're going to have and meet some of the parents in the community or whatever it may be. So it's important to be integrated into the community. All right. So. why is community assessment important and why is it important to include members of the community not in that passive participation but active participation well i'm going to tell you a little story because i mentioned if the community doesn't see something as a need or a problem your program or actions that you're doing won't be effective or helpful they won't even go to whatever you're setting up so I'm going to give you a little story here.

And I do have in the speaker notes, a link to, I got him from LinkedIn, actually looking at different programs that were epic fails. And there, I just found them fascinating because overall we've seen that happen when governments decide the government decides, Oh, we need a program for this. Then we need to do this. Then we need to spend this many trillion dollars on this. And then they don't ask the people who will be affected by it.

And it's a failure. So anyway, long story short, sort of, it's called the Turkana Fish Factory in Kenya. The Norwegian government came into this area.

It was called Lake Turkana. And they looked at a fish freezing, doing a fish freezing factory in this village. They saw that the lake was full of fish and they weren't being utilized by the local people. It was a very impoverished area.

It had few economic opportunities for the local farmers. They were mostly poor. And so the Norwegian government thought it didn't sound like a bad idea to just re-educate and train the local people to capture and process fish from this lake that's overflowing with fish that weren't being utilized. So...

They spent $150 million and built this factory and developed it and then had to abandon it. So why did it fail? Well, the people in that area, and I did pull this. I hope this is actually, it said it was from the Turkana fish freezing factory.

The people in that area, those local people, they did not eat fish. They believed that the... only the most desperate people should fish.

I don't know exactly what they said, local farmers. I'm not sure exactly what they did. It looks like maybe there's some crops in the area in the background.

I don't know. But it's a perfect example of not talking to the people who will be affected by what is happening. The Norwegian government would probably have been much better off taking that $150 million, not to mention the time and energy. they spent invested in the local infrastructure and build up businesses that so they could operate better things that already exist rather than the fish freezing factory so anyway until i was researching this little lecture here i didn't even know about so i um there are four other well-intentioned initiatives that went horribly wrong um if you're interested in reading so um It's important to learn about the community needs and their strengths. So there were local farmers.

There were some businesses. What could they do to possibly work smarter, not harder, and use the things that were there? So when we do data collection, we have two main sources.

We have primary data and secondary data that I want you to be very clear on. So when we talk about primary data, that is direct. through interaction with the community members. It may be community leaders. It may be people just within the community.

You may do participant observation. Go to the county health fair or the county fair. Go to events in the community.

Go watch what happens on Saturday mornings. Is there a park? What's going on? And that's some observation where you're one-on-one directly observing collective.

death. There may be a deliberate, again, sharing of life, attending some event. You might do key informant interviews.

You might just do a person, you know, be in the downtown and people walking by. Hey, can I talk to you about your community? Or it could be formal where you pull in specific people, you invite them or on Sunday or let's say Saturday morning, anybody who wants to come and talk about the community, come talk about the.

the community. You may do surveys. So we're going to talk a little bit more about windshield surveys in a second here. Town hall meetings. You may attend a town hall meeting, which is open to the public, and talk about what you're there for and how you want to gather data.

You may do specific focus groups, maybe moms of preschoolers and what resources do they have. You might do a focus group of them. Or.

high schoolers or young adults who don't currently have jobs or something like that. Just you're gathering direct interaction data. Secondary data is obtained through existing reports on the community. This is again, work smarter, not harder.

If there is information out there, you should be pulling it. Look at surveys that have already been completed. Maybe they've surveyed the community before.

Maybe a lot of high schools do behavioral risk surveys of their teens at certain grades, like all 10th graders or 9th graders or whatever, on behavioral risks, drug and alcohol use, tobacco use, self-harming behaviors, suicide, risk and depression. Those surveys are, if they're out there, pull that data. CDC has great data on social determinants of health.

There's... vital statistics data out there. The average income, average housing prices, the births, the mortality and morbidity rates, the levels of infectious disease, immunization, dental, there's all sorts of data.

Secondary data is wonderful. I'm a researcher. That's what I love, secondary data.

And then also advocacy organizations. There may be social services that has information on homelessness, child abuse. direct domestic violence, all of those things.

So we do data collection as part of our community assessment. We gather all that data. I do want to mention too, well, here, I'll talk about it here.

So when we talk about community assessments, I want to talk about windshield surveys because they can be the first step in the process of getting data that identify a lot of information about the community without having to do a lot of... primary like interviewing. It's very simple and inexpensive.

If you are on time constraints or a limited budget, windshield surveys are always a good, simple, inexpensive way to gather information. So it's involving going out into the community, taking pictures, taking notes. Usually there's like a, not a script, but like a tool that you use on where all you look.

You look at boundaries of the community. What is the typical employment? Are there factories?

Do people have more white-collar jobs, blue-collar jobs? What is the housing like? What's low-income housing like? Is there enough housing in general?

What is the transportation? If someone doesn't have an automobile, are they still able to get where they need to go? Is it a rural community? Is it an urban community or a larger community?

What kind of services are available? Are there physicians that are available? Or is it a small rural community and a physician from a larger area comes in once a week to see people and a dentist comes in once a month?

Or what does all that look like? And so why normally we do both in the morning and the evening, maybe on a day. a weekday and a weekend we're gathering data why do you think we would do both morning and evening when we're doing community assessment we i'll say pause the thing okay we want to look at that view of residents what that community looks like during the day when people are working and also in the evening when they're at home what do what do the um you What do the people do in the evening?

Are they going for walks? Is there a place to go for a walk? What does the housing look like? Is there peeling paint?

Are kids getting to school on a bus during the morning or are they walking home after school? Is there a place for them to play? I did put a picture here because this is a more current updated playground.

Is it a rural community and this is all they have? Or is it an area where maybe... taxes are they don't get as many taxes and so they don't do upgrades to areas like playgrounds and this slide is the any gen x or and some millennials even that was the slide of death because it was like 10 million stories high there was no little seat at the top there's just the top step and then you have to balance on there and go down if you had any sort of you skin showing it burned if it was over 80 degrees. If you had rubber shoes, you kind of stuck and almost fell over the side.

And this shows like sand or wood chips. Normally, it was in some compacted dirt here and you biffed it at the bottom and it was very unsafe. So long story short, you observe all of these type of things. You may look at churches. Are there a lot of churches?

Are there few churches? If it's a Wednesday evening, are there lots of people there? And then you're looking at what kind of nursing diagnosis you might start to identify here.

The book talks about some others. CDC has a tool called CASPER. There's some other map change.

Don't get too in the weeds on that. I just have it included there just because those might be some other options that... health department or a public health nurse might utilize. Okay, so let's talk about community diagnosis.

It looks a little bit different because, again, the community is our client, not someone, you know, one-on-one bedside nursing. So we still do that ADPAI, the assess, diagnose, plan, implement, evaluate. But as we identify a problem, it's a little bigger. It may be an actual problem.

problem or it could be a risk of a problem. So we might look at the increased number of clients in this community that are diagnosed with type 2 diabetes. And it may be related to inadequate access to the ability to exercise, walking trails, parks, and numerous fast food restaurants, and few primary care providers in the community.

This is just an example here. And then you may say it. evidenced by, from your secondary data, 200 new cases of type 2 diabetes in 12 months, and the age ranges and the percentage of female and male and the number of primary care providers for that population. And so your outcome might be to look at, you'd want a decrease in new cases, 20% decrease in new cases, 12 months after initiating.

preventative community diabetic education program and awareness campaign. Maybe you can hit those people who are borderline type two and reverse it and then have that many less new cases. So the community diagnosis then is what will drive the planning. So you'll take, which we're going to talk about in the next slide here, but you're going to take all these things that you've identified as problems and possible, put them into your whole ADPAI thing. And then you're going to prioritize them.

Another example could be risk of cardiovascular disease among people in this county due to lack of XYZ. So hopefully that makes sense. So we apply that nursing process. This is just kind of restating here.

We define the community. What is it? what is that group we want to look at? And then we collect the data.

We do the data. And then we analyze it so that we can identify those problems and rank them, prioritize those problems. And then we create those. Once we have those nursing diagnosis and we've prioritized them, then we'll look at the planning, implementation, and evaluation. We're going to talk about this in much greater detail in...

future topics. So I'm not going to get too in the weeds on it. But I do want to talk real quick here about the evaluation piece.

Because as you're doing your planning, you need to somewhat identify the type of evaluation that you may do depending on the plan. So and you know, you may have 10 different plans depending on, you know, 10 different not 10 is pretty broad. Let's say you may have three problems that you've identified that you're going to try to. create a plan for.

And depending on what that plan is, you'll need to evaluate it because that's the last piece of our ad pie. And so two main types of evaluation are formative and summative. Be familiar with those. Formative, I use the thesaurus of PowerPoint to find some other words. So it's shaping like taking when you think of a piece of clay and you shape it, then you can step back and look at it and say, you know what, that doesn't look right.

That ear, that ear should be on the forehead rather than the chin or whatever. I don't know. But you're shaping.

So you're doing that with the program. And what you do is you have at midway or at some pulse point throughout the program. program, you do a kind of a pulse check on how this program is going.

You may survey the participants and say, hey, we're meeting weekly. Is that something that works well for you? We're meeting, and they may say, weekly is fine, but this is what you weigh us every week. I'm just making this up on, say, it's a weight management plan. So they say, we meet.

every Monday and you weigh it. And we struggle on the weekends with following this program. We would prefer that we weigh every Friday. And so, I mean, that's something you could change and then apply that to the rest of the program throughout the length of the program. Summative is just what it sounds like.

Summary, you do it at the end of the program and it may be at the as soon as the program's over, you survey the participants. It could be, and it's not just participants, it could be maybe, again, how we talked about decreasing the incidence of type 2 diabetes. Your summative evaluation could be a year after it, what do the details look like as far as new cases or whatever it may be.

So you need to, and you may do both formative and summative. But you have to include that in your planning that, hey, halfway through, here's this survey we will be giving them. Or, hey, at the end, this is how we'll know what changes we need to do the next time we do this. So hopefully that makes sense. Okay.

So, as always, we always talk about levels of prevention, right? LOPs. And really, this one, when I put this together, it's very similar to what we've talked about before. for, but we always look at it.

So when we're talking about the community as the client, how does that look? Well, primary, it may be giving vaccines for the community. Maybe it's a community that's in a floodplain and sometimes they flood.

Primary prevention of tetanus, because they're at risk of being in a flood, is you would give tetanus vaccines for that community. Primary prevention. You don't want that community to get tetanus because they're in floodwaters or whatever. Secondary screening for hypertension. It's a community with a high risk of cardiovascular disease, high incidence.

Or it may be that community where we were talking about high numbers of type 2 diabetes every year. So you might do go to a community event and do. checks of blood glucose or draw hemoglobin A1Cs or whatever it may be, or tertiary, maybe you do take that group, that community that has those high incidences of type 2 diabetes, and you do some sort of class that talks about methods to bring down your hemoglobin A1C, maintain your diabetes.

with oral hypoglycemics or what you know all those type of things would be tertiary because the problem is already there and you're trying to keep it from worsening or improve you want it to improve that hopefully that summarizes okay primary prevention ppp secondary screening tertiary teaching education it won't always be quite so you cut and dried when we talk about levels of prevention. But again, this week it is. So hopefully that didn't take too long. And again, if you have any questions.

Do I say things that are different from the book? Probably often. So if something doesn't sound right, you read some information and it's different than what I talked about, always ask because I am human and I make errors. So thank you for hanging with me and I will talk to you again a different week.

Transcript for:NSG 440 Exam 2 - Topic 5

Transcript for:
NSG 440 Exam 2 - Topic 5