Module Components

• Overview

Topics

• Definitions
• Case Study: Curtis Bay
• Community Assessment and Diagnosis
• Role of the Public Health Nurse
• Resources for Assignments

Nurs 467 - Public Health Nursing

Module 3: Community Assessments, Analysis & Diagnosis

Community Assessment and Diagnosis

Community assessment is one of the three core functions of public health nursing and is the process of thinking critically about the community.

Steps in a Community Health Assessment

• Establish a working group, including community members
• Define the composition of the community
• Identify the information that needs to be collected
• Identify an organizing framework for collecting data
• Use existing data to describe the community’s strengths and weakness, assets, and liabilities.
• Gather new data as necessary
• Analyze the data using trends over time and making comparisons to similar localities and larger aggregates (state and national)
• Develop a profile of the community
• Identify vulnerable populations, unmet needs, resources, and unique characteristics
• Outline a plan for intervention based on findings
• Prepare a report and disseminate it to others
• Design, implement, and evaluate a project based on findings.

Read about Curtis Bay as it existed when Destiny was a child here (look at the sticky note comment on the first page to find out what pages to read).

Data-Gathering in a Community Health Assessment

Gathering data for a community assessment can be analogous to the assessment of a patient. In this class we will focus on three main types of data collection: windshield surveys, key informant interviews and collecting community health indicators.

A windshield survey is a common tool used in community assessment. The windshield survey provides an opportunity for direct observation of a community. Notes, pictures and video can be recorded to form the basis of a written report of the windshield survey. Compare the windshield survey to the head-to-toe patient assessment done by nurses at the beginning of a shift. We observe things like skin color, we document smells and sounds – all things that we wouldn’t necessarily know unless we were in the same physical space as the patient. Watch a video about the Curtis Bay windshield survey. Some of the video focuses on the adjacent community of Brooklyn, but they share many common characteristics.

The key informant interview is another method used to assess a community. Public health nurses meet and interview influential or key community members that can offer insight regarding community strengths, weaknesses and needs. This method can be compared to interviewing the patient, family members or members of the healthcare team to find out more information.

Denise is a student nurse at working with the school nurse at Benjamin Franklin High School at the same time that Destiny Watford is building a case against the new trash burning incinerator. She learns that the Environmental Integrity Project, a nonpartisan, nonprofit watchdog organization that advocates for effective enforcement of environmental laws, is also involved in Curtis Bay. Wanting to learn more about the organization’s involvement in Curtis Bay, she schedules an interview with one of their lawyers. Watch the video of this key informant interview.

Finally, public health nurses collect data on community health indicators. Some examples of health indicators include infant mortality, immunization and high school graduation rates. At the bedside, we do the same thing at the individual level when we look up our patient’s lab values, or examine their blood pressure trend over the past few days.

View data on the Curtis Bay community from the Baltimore City Health Department and the Baltimore Neighborhood Indicators Alliance.

By comparing the community data to health indicators at the city or state level, we can determine the status of health and health needs of our communities. We can also compare how we are doing to national goals, like Healthy People 2020. Click on the link to view the Healthy People 2030 Leading Health Indicators and Measures

Types of Data

Data can be qualitative or quantitative. Qualitative data will likely come from the windshield survey and key informant interviews, and often consists of words or phrases that describe the community. Quantitative data are the numbers (or “statistics”) that we typically think of – data that “quantifies” something about the community. For example, the percentage of people that smoke in a community is a piece of quantitative data.

Secondary data is data that already exists in various forms including data bases, via the internet and other data repositories. One very familiar source of secondary data is the Centers for Disease Control (CDC). There are four types of secondary data: demographic data, mortality data, morbidity data and life style behavior data.

Demographic data are the characteristics of the people, such as age, gender, education and income. The US Census is a good source for demographic data. Demographic data are often expressed as percent, for example, 51% of the community are women.

Mortality is the rate of deaths for all causes or specific causes. It is a vital statistic and is compiled from death certificates. This information can be found at State Health Departments. In Maryland it is found at the Department of Health. The statistic used to determine the overall health of a community, state and nation is infant mortality.

Morbidity is a rate of illness and can be found at local health departments and CDC websites. If you cannot find data for a specific illness it is because it is not a reportable disease. Check out Maryland reportable diseases.

Lifestyle behavior data often includes data on obesity, smoking, and substance abuse. See how Maryland residents are doing here. This site is great for several reasons: there are four years of data so you can determine a trend; you may compare to another county, the state and national data; and the categories (for example, health outcomes, length of life and quality of life) are ranked.

Additional state level data can be found at the CDC through the Behavioral Risk Factor Surveillance System. A comprehensive list of additional helpful sources of data can be found here.

ONCE DATA ARE GATHERED…

Now that different kinds of data on the community are gathered in one place, the public health nurse can get a comprehensive look at the different parts of a community:

• Community boundaries;
• Community goals;
• Physical and psychosocial characteristics;
• External influences;
• Internal functions of the community;
• Health behaviors and health status; and
• Feedback from internal and external sources.

The information gathered during the assessment is used to make a determination about the status of the community including: community strengths, weaknesses, needs, gaps in service and potential threats. Like a physical assessment, the information forms the basis for nursing intervention. This type of assessment gives rise to nursing diagnoses and interventions geared toward the most vulnerable in our communities.