A greater demand for community/population health assessment exists as the U.S. health care system shifts its focus from hospital-based care toward population- focused care. The concept of population-focused assessment is not new to nursing. Florence Nightingale pioneered this practice and recognized the physical and social environment as potential causes of illness. Nightingale analyzed England’s census data in 1861 and this data analysis became the foundation for England’s sanitary reform acts.
Traditionally, community and public health nurses have conducted health assessments of entire geopolitical communities and of at-risk populations, focusing on the health of the entire community rather than the individual’s health. Today, public health nurses participate in all facets of community assessment and are well-suited to lead community assessment projects. In fact, the first standard in the Scope and Standards of Practice: Public Health Nursing is assessment: “the public health nurse collects comprehensive data pertinent to the health status of populations” (2013, p. 28).
Through this population-focused assessment, community public health nurses envision changes in community norms, safer neighborhoods and a greater consciousness about health issues. (Lundy and Janes, 2009).
A good community diagnosis uses this format:
Risk for ________ among ________ related to ________ as evidenced by ________.
These are not NANDA nursing diagnoses! A community diagnosis can be broad like this:
Increased risk of early mortality among residents of Curtis Bay related to exposure to pollution, lack of access to healthy and affordable food, high smoking rates, and low levels of physical activity, as evidenced by higher than average morbidity rates from airway and coronary diseases.
Or more narrow like this:
Increased risk of pediatric hospital admissions for asthma among Curtis Bay children aged 2-16 related to poor adherence to preventative medication, as evidenced by increased pediatric visits to urgent care and the ED for asthma exacerbations.
Both of these diagnoses are accurate—which one you use depends on the point you are trying to make and what sort of intervention you are proposing. If you want to intervene at the systems/policy level to improve health overall, you would use the first diagnosis. If you want to start a program targeted at reducing pediatric hospital admissions for asthma by improving adherence, then go with diagnosis two.
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