Community Health Planning,
Implementation, and Evaluation
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Community as Client
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2
Community Health Nursing Practice
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3
Client Example Characteristics Health
Individual Lisa McDonald Individual with various
problems, and needs
Family Moniz family Family system with
individual and group
Individual and family
strengths, problems, and
individuals and the family
Group Boy Scout
problems, and needs
Fulfillment of goals
Group member and
in a given state
group with common
interests, problems, and
Assessment of common
problems, needs, and
Application of nursing
process to identified
Organization A workplace
Organized group in a
common location with
shared governance and
Relationship of goals,
of organization to its
strengths, problems and
employee application of
nursing process to
An aggregate of people
in a common location
with organized social
Analysis of systems,
problems, and needs
participant, and health
Health Planning Model
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4
Steps in the Health Planning
ïƒ˜ Meet with group leaders of aggregate to clarify mutual
ïƒ˜ Determine sociodemographic characteristics
ïƒ˜ Interview a key informant
ïƒ˜ Consider both positive and negative factors
ïƒ˜ Compare the aggregate with the â€œnormâ€
ïƒ˜ Research potential problems
ïƒ˜ Identify health problems and needs
ïƒ˜ Prioritize the identified problems and needs to create an
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5
Four Types of Needs to Assess
ï‚˜ Expressed needs
ïƒ˜ Demand for services and the market behavior of the targeted
ï‚˜ Normative needs
ïƒ˜ Lack, deficit, or inadequacy of services determined by health
ï‚˜ Perceived needs
ïƒ˜ Wants and desires expressed by audience
ï‚˜ Relative needs
ïƒ˜ Gap showing health disparities between advantaged and
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6
Factors for Determining Priorities
ï‚˜ Aggregates preferences
ï‚˜ Number of individuals affected by the health
ï‚˜ Severity of the health need or problem
ï‚˜ Availability of potential solutions
ï‚˜ Practical considerations such as skills, time,
and available resources
ï‚˜ May use Maslowâ€™s hierarchy of needs or
levels of prevention to further refine priorities
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7
Community Involvement Is Essential
â€œStart where the people are!â€
ï‚˜ Five spheres of empowerment
ïƒ˜ Interpersonal (personal empowerment)
ïƒ˜ Intragroup (small group development)
ïƒ˜ Intergroup (community)
ïƒ˜ Interorganizational (coalition building)
ïƒ˜ Political action
â€“ Labonte (1994)
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8
Steps in the Health Planning Model
ïƒ˜ Determine the intervention levels
â€¢ Subsystem, aggregate system, and/or suprasystem
ïƒ˜ Plan interventions for each system level
â€¢ Primary, secondary, or tertiary levels of prevention
ïƒ˜ Validate the practicality of the planned
interventions according to available resources
â€¢ Personal, aggregate, and suprasystem
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9
Development of Goals and
ï‚˜ Goalsâ€”where we want to be
ï‚˜ Objectivesâ€”steps needed to get there
ïƒ˜ Specific measures
ïƒ˜ Instructions to guide population
ïƒ˜ Used to measure outcomes
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10
Steps in the Health Planning Model
ïƒ˜ Often the most enjoyable stage for the nurse and
ïƒ˜ Implementation should follow the initial plan
ïƒ˜ Should include a variety of strategies
ïƒ˜ Prepare for unexpected problems
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11
Type of Aggregate and System Level
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12
Project Type of Aggregate System Level for Intervention
Rehabilitation group Group Subsystem and aggregate system
Textile industry Organization Aggregate system and suprasystem
Crime watch Group, organization,
and population group
Aggregate system and suprasystem
Community Aggregate system and suprasystem
Steps in the Health Planning Model
ïƒ˜ Include the participantâ€™s verbal or written feedback and the
nurseâ€™s detailed analysis
ïƒ˜ Reflect on each previous stage to determine the planâ€™s
strengths and weaknesses
ïƒ˜ Evaluate both formative (process) and summative
ïƒ˜ Communicate follow-up recommendations
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13
Importance of Each Step in the
ï‚˜ Aggregate assessments must be thorough.
ïƒ˜ Should elicit answers to key questions about the aggregateâ€™s
health and demographic profile
ïƒ˜ Should compare this information with similar aggregates
presented in the literature
ï‚˜ The nurse must complete careful planning and set
goals that the nurse and the aggregate accept.
ïƒ˜ Mutual planning is very important.
ï‚˜ Interventions must include aggregate participation
and must meet the mutual goals.
ï‚˜ Evaluation must include process and product
evaluation and aggregate input.
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15
Federal Legislation Affecting Health
ï‚˜ Hill-Burton Act
ï‚˜ Regional Medical Programs (RMP)
ï‚˜ Partnership for Health Program (PHP)
ï‚˜ Certificate of Need (CON)
ï‚˜ National Health Planning and Resources
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16
Comprehensive Health Reform
ï‚˜ Patient Protection and Affordable Care Act
ïƒ˜ Preventive services based on evidence-based
ïƒ˜ National strategy to improve the nationâ€™s health
ïƒ˜ CMMS innovation center
ïƒ˜ National quality improvement strategy for services
and population health
ïƒ˜ Improved access to care
ïƒ˜ Reduction in the growth of Medicare spending
ïƒ˜ National workforce strategy
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17
ï‚˜ Work collaboratively with health planners to
improve aggregate health
ï‚˜ Fuse technology with knowledge of health
care needs and skills
ï‚˜ Become directly involved in the planning
ï‚˜ Engage in aggregate-level projects
Copyright Â© 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18
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