Community assessment: application to community/public health nursing practice
Chapter 15 Community Assessment
Sergio Osegueda Acuna, MSN-FNP-BC
MRC
Community assessment: application to community/public health nursing practice
Assessment, the first step of the nursing process, forms the foundation for determining the client’s health. Regardless of whether the client is an individual, a family, or a community.
Nurses gather information by using their senses. As well as their cognition, past experiences, and specific tools.
These data are analyzed to make diagnoses about the community’s health status and allow the nurse to answer the question, “How healthy is this community, or what are its strengths, problems, and concerns?”
Components of Healthy Communities
Low crime rates
Good schools
Strong family life
Robust economy, good jobs
High environmental quality (clean air, water)
Accessible and quality health services
Adequate housing
Civic involvement
Nice weather
Good transportation (roads, public transportation)
Wide variety of leisure activities
Exposure to the arts
Reasonable taxes
Community defined
Community is defined as an open social system that is characterized by people in a place who have common goals over time.
Aggregate is any number of individuals with at least one common characteristic (Williams, 1977). The terms population group and aggregate are synonyms for population (Williams, 1977)
Population is a collection of individuals who share one or more personal or environmental characteristics, the most common of which is geographical location (Schultz, 1987).
Critical Components of a Community
People, Population is the most obvious of the necessary community components.
Place, traditionally, communities were described in relation to geographical area.
Social interaction or common characteristics, interests, or goals.
Geopolitical
The geopolitical community is a spatial designation—a geographical or geopolitical area or place.
Geopolitical communities are formed by either natural or human-made boundaries. A river, a mountain range, or a valley may create a natural boundary
Human-made boundaries may be structural, political, or legal.
Political boundaries may be exemplified by congressional districts or school districts.
Phenomenological
Another way of thinking about community is in terms of the members’ feeling of belonging or sense of membership, rather than geographical or political boundaries
People in a phenomenological community have a group perspective that differentiates them from other groups.
A group consists of two or more people engaged in an interdependent relationship that includes repeated face-to-face communication.
A group’s identity may be based on culture, beliefs, values, history, common interests, characteristics, or goals.
Social Interaction or Common Interests, Goals, and Characteristics
Communities, similar to families, have their own patterned interaction among individuals, families, groups, and organizations; this interaction varies from community to community depending on needs and values.
In a geopolitical community, this interaction may go beyond talking to one’s neighbor and may include interactions with agencies and institutions within the community.
A phenomenological community exists because of a common interest or feeling of belonging (Dreher & Skemp, 2011).
Nursing Theories Applicable to Community Assessment
Most nursing theories were developed for individual clients, not communities (Alligood & Marriner-Tomey, 2010; Hanchett, 1988).
Many nursing theories view the community as the environmental system influencing individuals and families.
Only a few nursing theories view the community as client (Hamilton & Bush, 1988). Goeppinger and colleagues (1982) proposed the development of a community assessment tool using Cottrell’s characteristics (1976) of a competent community as a framework.
Community competence is based on eight variables:
Commitment
self and other awareness and clarity of situation definitions
Articulateness
Communication
Conflict containment and accommodation
Participation
Management of relations with the larger society
Machinery for facilitating participant interaction and decision making
Basic Frameworks Used to Assess Communities
Developmental Framework Information about the community is collected from several points in time because communities change
Epidemiological Framework An epidemiological perspective focuses on the health of the population. In this approach to community assessment, the nurse identifies persons who are at greater risk of illness, injury, disability, and premature death so that targeted interventions aim at reducing the risk or preventing the problem
Health Disparities and At-Risk/Vulnerable Populations
Structural–Functional Framework
Overview of Systems Theory
Dorothy Johnson:
Successful community functioning and adjustment to environmental factors
Sister Callista Roy:
Effectiveness of the community in accomplishing its functions and adapting to external stimuli
Imogene King:
Quality interactions between individuals, groups, and the entire community that contribute to community functioning and development
Betty Newman
Competence of the community to function and maintain balance and harmony in the presence of stressors
Jean Watson:
A healthy community is a holistic community. One which is able to integrate social and personal resources and capacities to attain or maintain health for its members
Boundaries
A community is defined in terms of the three critical components: people, place, and social interaction or common interests.
Defining the boundary also identifies the suprasystem, the environment outside the community.
Data collected from the suprasystem are considered external influences, or inputs, and may impact or influence the community.
Boundaries, similar to the skin of an individual, maintain the integrity of the system and regulate the exchange between a community and its external environment, the suprasystem.
Permeability of Boundaries
The boundaries of any system may be relatively permeable (open) or impermeable (closed).
A geographical community that has a gated entrance. And homes that cost $350,000 or more is impermeable to people with an annual income of $25,000 to $30,000. Communities with greater variety of housing prices and rental units would be open to more people; thus the boundaries would be permeable.
For example, entrance or membership into a religious community may be contingent on accepting certain beliefs and rituals. Making the boundary impermeable to someone who does not hold these beliefs.
