Care of Populations Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458...

Care of Populations

Copyright ©2008 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.Community Health Nursing, 5/eMary Jo Clark

15CHAPTER

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Population Health Management

• Accountability and management of health of entire community

• Regardless of system membership or insurance status

• Health promotion

• Illness prevention strategies



Population Health Assessment

• Benefits of including member of community– Ensures that their interests are considered– Accurate and comprehensive appraisal of

health status– Aids in offsetting organizational or agency

agendas that may arise– Assures a comprehensive/balanced picture of

health



Rapid Participatory Appraisal

• Addresses community structure, composition, interest, and capacity

• Collects data regarding community needs and assets

• Identifies available services

• Considers social policy as it affects capacity to meet population health needs



Key Concepts

• Community

• Target group

• Community engagement



Factors Affecting Population Health: Biophysical Considerations

• Annual birth rate

• Age dynamics

• Age-specific death rates

• Genetics

• Race/ethnicity

• Disease incidence and prevalence



Psychological Considerations

• Community stressors

• Suicide and homicide rates

• Adequacy of law enforcement

• Communication patterns



Physical Environmental Considerations

• Geographical location

• Type and size of community

• Topographical features

• Climate



Physical Environmental Considerations (continued)

• Type and adequacy of housing

• Water supplies

• Disaster potentials



Sociocultural Considerations

• Community government and leadership

• Language

• Income and education

• Employment levels and occupations



Socioculutral Considerations (continued)

• Marital status/family composition

• Religion

• Transportation

• Availability of goods and services



Behavioral Considerations

• Consumption patterns

• Nutritional levels

• Use of harmful substances

• Prevalent leisure activities



Health System Considerations

• Existing health services

• Level of health system performance

• Availability and adequacy of services

• Health care financing

• Community’s definition of health and illness



Principles of Population Health Assessment

• Seek multiple sources of information

• Address needs of specific subgroups

• Involve all potential stakeholders

• Identify population assets, needs, and problems

• Use experts to conduct or direct assessment



Components of a Population Nursing Diagnosis

• A potential adverse situation or risk

• Identification of the group or population at risk

• Group factors or characteristics contributing to the risk

• Indicators that support the conclusion that an increased risk is present



Planning

• Collaborative, systematic process to attain a goal

• Collaboration through involving community and stakeholders

• Systematic process– Effective health systems respond to/are accountable

to needs of population– Limited resources must be used to population’s

greatest advantage– Health supersedes other economic or social ends



Program Planning

• Utilizes five step process:– Define and prioritize issue to be addressed– Create the planning group– Analyze the issue– Develop the program– Set the stage for evaluation



Define/Prioritize Issue to Be Addressed

• Severity of threat

• Degree of community’s concern



Categories to Include When Creating a Planning Group

• Those in authority who approve program

• People with expertise related to issue

• Those who will implement program

• Those who will benefit from program

• Those who might resist program



Analyze Issue

• Contributing factors

• Alternative solutions

• Determine level of prevention for problem resolution

• Determine costs, feasibility, and acceptability



Analyze Issue (continued)

• Determine availability of necessary resources

• Determine efficiency

• Determine equity

• Identify political advantages



Develop Program

• Outcome objectives– Immediate, intermediate, and ultimate

outcomes

• Process objectives:– Designate level of expected staff performance



Evaluation Criteria

• Determine evaluation criteria

• Types of collection data

• Means of collecting data

• Resources needed to conduct evaluation

• Identify who will evaluate the program



Program Theory

• How elements of a program interact to produce outcomes

• Conceptual model of planned interventions and outcomes

• Graphically displayed interrelationships– Critical elements– Expected outcomes



Theory Types

• Theory of cause and effect:– Links interventions with outcomes

• Theory of implementation– Describes strategies for program

implementation



Theory Types

Partial Program Theory for a Smoking Cessation Program



Levels of Acceptance

• Community policy makers

• Program implementers

• Members of target group:

• Potential resistors:



Acceptance by Policy Makers

• May involve nurse as advocate



Acceptance by Program Implementers

• May only involve making plan operational



Acceptance by Members of Target Group

• May require marketing to that group



Acceptance by Potential Resistors

• Critical to success or failure of program

• Early involvement can positively influence this group



Program Evaluation

• Justify program continuation/expansion

• Improve quality of service

• Determine future courses of action

• Determine impact of program



Program Evaluation (continued)

• Call attention to the program

• Assess personnel performance

• Assuage political expectations

• Make better programmatic decisions



Considerations in Program Evaluation

• Purpose of the evaluation

• Who should conduct the evaluation

• Political considerations

• Ethical considerations

• Type of evaluation to be conducted– Prospective– Retrospective



Resources

• Community Assessment & Collaboration This Washington State community site contains access information about the health and health concerns of a community, and offers tools to better reach out and to involve the community with these issues.



Resources

• American Public Health Association Population, Family Planning andReproductive Health Section. Section members work to improve the health of women, men and children by ensuring that population, family planning and reproductive health remain major domestic and international priorities.



Resources

• Texas Department of State Health Services, Children with Special Needs

Site describes various programs developed for this special population. Their mission is to support family-centered, community-based strategies for improving the quality of life for children with special health care needs and their families.

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