Geopolitical And Phenomenological Place Influence Essay<\/p>\n
Discuss how geopolitical and phenomenological place influence the context of a population or community assessment and intervention. Describe how the nursing process is utilized to Help in identifying health issues (local or global in nature) and in creating an appropriate intervention, including screenings and referrals, for the community or population. 3 citations needed within 5 years.Geopolitical And Phenomenological Place Influence Essay<\/p>\n
Permalink: https:\/\/nursingassignmentacers.com\/geopolitical-and\u2026-influence-essay\/ \u200e<\/p>\n
Geopolitical and Phenomenological Community<\/p>\n
A geopolitical community is a spatial designation that is defined by either man-made or natural boundaries. It is a geographic of the geopolitical designation of an area. It is geopolitical because it is defined by the political and geographical phenomena. The boundaries include rivers, mountains, valleys and roads. On the other hand, a phenomenological community is a relational designation. It is defined by feelings of belonging. A phenomenological community is said to be a group of people who are defined by sharing values, customs, interests, religion or academic interests. It is a phenomenological community because members share common beliefs and interests.<\/p>\n
While providing services for different communities, community health nurse faces the challenge of adaptability (). Since the nurses have to identify themselves with the community they are serving, they may have difficulties adapting to the practices, beliefs and expectations of the different communities within a short span of time. They also experience the challenge of language barrier and acceptability. However, it is beneficial for them since they attain the experience of dealing with the different communities. For similar communities, community health nurses may be faced with the challenge of familiarity. For the same community, a community health nurse may face the challenge of being used to the people. In some instances, the members of the same community may view the community health nurse as inexperienced, and may not take what the nurse says seriously. Some benefits for similar and the same community are that the community health nurse is familiar with the language and the beliefs of the people one is serving. Such benefit eases the work of the community health nurse.Geopolitical And Phenomenological Place Influence Essay<\/p>\n
Some solutions for the challenges would include matching a solution for a specific challenge. For example, community health nurses may be Helped by interpreters where there is a language barrier, or take some time to study the language of the people. In addition, the nurses should not be transferred anyhow to communities that are very different from their backgrounds. For similar and same communities, the community health nurses should carry themselves with dignity in order to command respect from the community members, who will in turn consider them serious.<\/p>\n
Geopolitical is a destination, a geographical area or place, it can either be formed by manmade boundaries such as a street, bridges, highway, or by natural boundaries like mountains. I live in Tucson and my boundaries are set by the city. Tucson boundary lies next to Marana. Studies in epidemiology and statistics in my area will be done by the geographical area. Phenomenological community is where I live, I live in a middle class neighborhood with children of the same age as mine, and the neighbors are like minded such as myself. We all go to work pay our bills, raise children and have a quiet family life (Maurer & Smith, 2013).Geopolitical And Phenomenological Place Influence Essay<\/p>\n
A phenomenological community exists because the people in it have a common interest. I live in a geopolitical community but I might be a member of several phenomenological communities (Maurer & Smith, 2013) For example my job is where I belong, I have friends as well as coworkers there and we all have one common goal, to do the best by our patients.
\nChallenges for the nurse may arise when dealing with a community that has a high crime rate, and other issues as opposed to another community that does not. The nurse needs to gather data and use theory models to solve those issues. Two models are available to nurses when doing community health, community as partner model, and energy theory. Both views see community as a network (Maurer & Smith, 2013). If the nurse uses these models the nurse works in partnership with the community to address concerns. Looking at the community with these models is used to determine where the needs are, one community may be older population and need education on heart disease, another community may have a high number of females and need more health services for women. Understand customs and beliefs is needed by the nurse when planning an intervention for this community, there are phenomenological communities such as Sons of Norway club that are based on the cultural heritage. The nurse should also look at the community\u2019s strength and build upon it (Maurer & Smith, 2013).Geopolitical And Phenomenological Place Influence Essay<\/p>\n
This pack provides practical help and guidance to a nurse1 undertaking community health
\nneeds assessment. It provides information and advice on the stages of needs assessment,
\nenabling the nurse to complete the process realistically within her\/his everyday work. This
\npack does not assume any prior knowledge of the subject.
\nWhat is a community health needs assessment?
\nCommunity health needs assessment is a process that:
\ndescribes the state of health of local people;
\nenables the identification of the major risk factors and causes of ill health; and
\nenables the identification of the actions needed to address these.
\nA community health needs assessment is not a one-off activity but a developmental process
\nthat is added to and amended over time. It is not an end in itself but a way of using
\ninformation to plan health care and public health programmes in the future.
\nThe steps of community health needs assessment are as follows.
\nProfiling
\nthe collection of relevant information that will inform the nurse about the state
\nof health and health needs of the population; and
\nanalysis of this information to identify the major health issues.
\nDeciding on priorities for action
\nPlanning public health and health care programmes to address the priority issues
\nImplementing the planned activities
\nAssessment of health outcomes
\nWhy do it?Geopolitical And Phenomenological Place Influence Essay
\nNeeds assessment will enable the nurse to:
\nplan and deliver the most effective care to those in greatest need;
\napply the principles of equity and social justice in practice;
\nensure that scarce resources are allocated where they can give maximum health
\nbenefit; and
\n1
\nThe term \u201cnurse\u201d is used as a generic term throughout this pack to cover all nurses, midwives and public
\nhealth nurses.
\n2
\nwork collaboratively with the community, other professionals and agencies to
\ndetermine which health issues cause greatest concern and plan interventions to
\naddress those issues.
\nConcepts and principles of health needs assessment
\nDefining \u201chealth\u201d and \u201cneed\u201d
\nThis pack uses a holistic model of health, emphasizing the social, economic and cultural
\nfactors that affect health as well as individual behaviour. The concept of \u201cneed\u201d used in this
\npack incorporates those needs felt and expressed by local people as well as those defined by
\nprofessionals. It moves beyond the concept of demand and takes account of people\u2019s
\ncapacity to benefit from health care and public health programmes.
\nFactors affecting health
\nHealth is affected by a number of factors:
\nthe physical environment in which people live, such as the quality of the air they
\nbreathe and the water they drink;
\nthe social environment \u2013 the level of social and emotional support people receive
\nfrom friends and\/or family;
\npoverty, a significant factor worldwide, which shortens and reduces enjoyment of
\nlife;
\nbehaviour and lifestyle \u2013 for example, smoking causes lung cancer and coronary
\nheart disease so a reduction in this behaviour will reduce the disease; and
\nfamily genetics and individual biology \u2013 if you come from a healthy family you
\nhave a better chance of staying well.Geopolitical And Phenomenological Place Influence Essay
\nThis pack will encourage the nurse to consider all these risk factors in relation to a
\ncommunity and make an assessment of their importance.
\nInvolving the community
\nIt is assumed that the nurse using this pack has responsibility for providing nursing
\nservices to a caseload of individual patients and a wider responsibility for improving the
\nhealth of the community.
\nThe pack also assumes that the nurse wishes to work in partnership with local people and
\nwill be looking for ways to involve others in her\/his work. Community needs assessment
\nincorporates many of the principles of community development (Appendix 1), which has
\nbeen defined as: \u201c\u2026a way of tackling a community\u2019s problems by using the energy and
\nleadership of the people who live there\u201d (Thomas 1995).
\nInvolving other professionals and agencies
\nIf people feel involved in developing a local health plan they will be more committed to
\nputting it into action. It is therefore important that all those who will be involved in using
\n3
\nthe plan are also involved in the health needs assessment process. For the nurse this means
\ncollaborating with other professionals and the local community. Nurses will also need to
\nagree with their employers on the flexibility and autonomy to change their work patterns
\naccording to the needs identified through the community needs assessment process.
\nFormat of the pack
\nThe pack takes a user-friendly approach to community health needs assessment, guiding
\nthe beginner through the process. Section One outlines the type of information a nurse
\nneeds to think about when creating a profile of the community. Reasons are given for the
\ninclusion of each piece of information. Section Two gives practical advice on how a nurse
\nmight find this information. Section Three helps the nurse to analyse and use the
\ninformation, decide on priorities and create action plans. By working through the pack, the
\nnurse will gain a basic knowledge of the health needs assessment process and will be able
\nto begin this task within his\/her own work setting.
\nBefore starting
\n1. The nurse should read through this pack to become familiar with the complete
\nhealth needs assessment process.
\n2. Other key local people and professionals whom the nurse would like to be
\ninvolved in the work should be approached. Ideally, these people will form a
\nworking group to develop the community health needs assessment together.
\n3. The scope and purpose of the health needs assessment should be decided on. Will
\nthis be a way of planning work for local community nurses, or will it identify
\nhealth service needs on a wider scale and make recommendations to other
\nproviders of services? These decisions will influence the approach taken.Geopolitical And Phenomenological Place Influence Essay
\n4. People who will be able to help with the community health needs assessment
\nshould be identified. These may be local community leaders, whose approval may
\nallow greater access to communities, or local administrative staff who may have
\nuseful information. Access to someone with an understanding of epidemiology or
\nstatistics would also be helpful, but is not vital.
\n5. The nurse must decide how much time and resources he\/she is realistically able to
\ngive to the work, and adapt each stage of the process to take account of this.
\n6. Consideration should be given to the ethical issues regarding ownership and use
\nof information, confidentiality, raised expectations versus unmet needs, and the
\ndangers of stigmatizing groups and communities.
\n4
\nSection One: Profiling the population
\nThink about what you want to find out about your local population. What information will
\nhelp you define and describe the community and its health needs? You may find it helpful
\nto ask yourself the following questions.
\n1. What are the key characteristics of the population?
\n2. What is the health status of the people?
\n3. What local factors are affecting their health and what impact do they have (good
\nand bad)?
\n4. What services are currently being provided?
\n5. What do local people see as their health needs
\n6. What are the national and local priorities for health?
\nThis section describes the type of information that you may find useful when answering
\nthese questions. What you choose to include in your profile is up to you and will depend on
\nlocal circumstances and the availability of information. Do not be tempted to collect too
\nmuch information; this is time consuming and makes it difficult to use the profile. It is
\nmore important to define clearly the questions you want to answer and spend the time
\nacting on the information you have collected.
\nCharacteristics of the population
\nA number of elements will enable you to describe the community you work in:
\nGeography: which area\/population does this profile cover?
\nA description of a community includes its location. It is assumed that the community
\nidentified will coincide with the nurse\u2019s area of responsibility. You may be responsible for
\na village with distinct and recognizable boundaries, a section of a town with named roads
\nmarking the outer limits, or a refugee camp. If you are responsible for a population with no
\nfixed location, such as nomadic or homeless people, describe the people themselves rather
\nthan the location. Defining the boundaries is necessary to identify who is included within a
\ncommunity and to aid information collection. If possible, match the boundaries you choose
\nwith administrative ones, especially if information is already collected on that basis or
\nother local workers share responsibility for the same population.
\nNumbers: how many people?
\nThe total number of people within the community should include all people from birth to
\ndeath. This will show the number of people the community assessment is designed to
\ncover.<\/p>\n
5
\nAge distribution: what age are they?Geopolitical And Phenomenological Place Influence Essay
\nIt is important to examine the age distribution of a community because this will have a
\nmajor influence on health needs. Most profiles divide the community into the following
\nage bands:
\npre-school children
\nschool-age children and young people
\nadults
\nelderly people.
\nThe old and young age groups in a population have greater health care needs. This does not
\nnecessarily imply, however, that a community that has a large dependent population (i.e.
\nmany children and elderly people) will use the majority of its resources to care for those
\ngroups. It may instead choose to invest resources in maintaining the health of adults, as
\ntheir ability to work and function is key to maintaining the dependent groups.
\nGender distribution: how many males and females?
\nThe ratio of males to females in a community obviously also has a major bearing on the
\ncommunity\u2019s health needs. Gender distribution has some standard patterns on a large scale,
\nsuch as more boys are born than girls and there are more women than men in the very old
\nage group. It is important to know whether your community fits this pattern, as this will
\naffect the range of services required. Gender is also important when looking at specific
\nhealth issues, such as family planning, maternity services or diseases that are genderspecific, such as ovarian cancer.
\nEthnicity and religion
\nMinority ethnic and religious groups can be marginalized within a community; a lack of
\nawareness can result in a community health needs assessment that may not include the
\nmost vulnerable groups. Nurses need to be aware of the different ethnic and cultural groups
\nwithin the community. Ethnic groups can be classified by racial origin, religion, colour or
\nnationality. You may choose to use the national classification so that you can make
\ncomparisons with other areas. Different groups face different problems and require services
\nthat are sensitive to their cultural and linguistic background. This can be seen in diseases
\nthat are specific to one group such as sickle cell anaemia and thalassaemia. Religious
\ngroupings are useful to know, as they can have a powerful influence over people\u2019s lives
\nand are often a source of community support and influence health behaviour.
\nEthnicity and cultural background have a significant impact on health, and individuals,
\nwhatever their ethnic background, are entitled to equal access to health care. Even if the
\nnumbers are small, nurses should take action to ensure equality of access to health care and
\nhealth programmes that are culturally and linguistically appropriate.
\nPopulation trends: patterns over a period of time
\nPopulation trends give an indication of patterns of disease and the need for services. The
\nbirth rate (Appendix 2) going up or down may suggest that a population is increasing or
\n6
\ndecreasing, and may also indicate a need for service changes. The mortality rate
\n(Appendix 2) can give information about the size of a population and its state of health.
\nLanguage and literacy
\nThere may be one or many languages in use within the community, together with local or
\nregional dialects. Language and literacy are essential for communicating health
\ninformation and for accessing services. If literacy is a problem within the community, be
\nsensitive to this and take account of it when deciding on methods of community
\nparticipation. Knowledge of local minority languages is vital to ensure equity and to enable
\nthe whole community to become involved in the community health needs assessment
\nprocess.
\nThe health status of the population
\nThere are different ways of finding out about the health status of the community:
\npeople\u2019s own views of their health
\nstatistical information
\nqualitative surveys
\nthe knowledge of local health care workers and other agencies.Geopolitical And Phenomenological Place Influence Essay
\nThere are a number of measures commonly used to identify the health of a population.
\nMortality data
\nThis generally describes patterns of death in relation to age, gender and cause of death. It is
\na basic measure of epidemiology \u2013 the study of disease in populations. Information is
\ncollected nationally, regionally and sometimes at local level, usually from death
\ncertificates. It indicates deaths from disease, accidents, suicides and homicides, and the
\ngeneral health of the population in terms of life expectancy (Appendix 2). Mortality rates
\nwork best for large populations; in small communities a little change can produce large
\nstatistical distortions. A problem in using mortality rates is that they depend on a shared
\nunderstanding of cause of death and do not describe the health of the living.
\nMorbidity data
\nThis is information on types of illness and disability, their incidence and prevalence. It can
\nbe taken from a wide range of sources including hospital records, infectious disease
\nnotifications and disability registers, sickness records, general medical practice, child
\nhealth records, census material and other surveys. Information collected in this way should
\nbe treated with care, as it may be a measure of health service activity rather than true
\ndisease patterns. It is a reflection of illness and not health.
\nBehaviour measures
\nThese are often used as indicators of health. Smoking is one of the best examples. This is
\nan activity proven to cause ill health, so if a lot of people smoke it shows a large potential
\nfor illness in the population. Breastfeeding is considered the best of all infant feeding
\n7
\nmethods, so it is taken as an indication of good health. These measures should be treated
\ncarefully as they are about behaviour, yet are sometimes used as proxy measures for health.
\n\u201cQuality of life\u201d measures
\nThese are a means of assessing physical health, functional ability and psychological
\nwellbeing. The assessment scales are based primarily on an individual\u2019s own assessment.
\nThese have been developed mostly in North America and the United Kingdom to measure
\nhealth outcomes based on people\u2019s perception of their health. The reliability and validity of
\nthese tools vary, but they are still useful in providing people-based measures of health.
\nExamples include the Barthel Index, the Nottingham Health Profile and the Index of
\nActivities of Daily Living.2
\nUse of service information
\nThis information can help build a picture of morbidity as it can describe the diseases that
\nare being treated by the health services. It will cover both treatment, for example hospital
\nadmissions, and uptake of preventive services, such as immunization and screening
\nprogrammes. Care may need to be taken, however, as some health problems may not yet
\nhave any services. In countries where access to services is limited through inadequate
\nprovision or an individual\u2019s ability to pay for treatment, this information will often be
\nunreliable as an indicator of population health.
\nHealth inequalities
\nIt is essential to collect information, not only about health and disease but also about health
\ninequalities. This applies to rich and poor countries alike. Most disease and illness patterns
\nrelate closely to economic circumstances, so that those in poverty suffer disproportionately
\nhigh rates of poor health. Health statistics reveal that, even where death rates improve for a
\ndisease, this is less likely to be true for the poorer sections of the population. For this reason
\nit will be important to record patterns of health inequality in your local population. When
\nconsidering equity you may find it useful to ask yourself the following questions.
\nWho is disadvantaged in this community?
\nWhy are they disadvantaged?
\nWhat can I do about it?
\nWho has unmet needs in this community?
\nWho does not access care in this community?Geopolitical And Phenomenological Place Influence Essay
\nLocal factors affecting health
\nA number of local factors may affect health. In each community this will be different. You
\nwill need to think about collecting the following information for your profile:
\n2
\nBOWLING, A. Measuring health: a review of quality of life measurement scales. Buckingham, Open
\nUniversity Press, 1991.
\n8
\nWork and employment
\nWork and levels of employment and unemployment in a community are fundamental to
\nhealth for the following three reasons.
\nOccupational diseases. All work affects health, both positively and negatively. However,
\nsome work is known to cause disease, such as silicosis in mine and quarry workers and
\nmachinery accidents among farm workers. New work-related illnesses are also being
\nrecognized, such as repetitive strain injury for keyboard operators.
\nIncome levels. The amount of income people earn has an important influence on their
\nhealth, affecting their ability to choose a healthy lifestyle and to access health services.
\nLevels of income also have an impact on the local economy within a community.
\nSelf worth. The status of an occupation affects how people feel about themselves. People\u2019s
\nlevel of satisfaction at work contributes to their wellbeing. Many define people by their
\nwork or lack of it. The unemployed may feel excluded, and lack of paid employment has
\nbeen shown to contribute to poor health.
\nPoverty and income
\nPoverty can be absolute (i.e. inadequate to sustain health) or relative (i.e. how poor one
\nperson is compared to another). In health terms, it is not only the level of poverty that
\ncounts but also the gap between richest and poorest. A large gap results in a big difference
\nin health and life expectancy between rich and poor. This is known as health inequality. It
\nis one of the most significant factors affecting health across the world and therefore
\ninformation on this issue will be essential.
\nEnvironment
\nThe surroundings we live and work in directly affect health. A number of factors should be
\nmonitored here.
\nPollution. Pollution of air and water causes disease and death and this is evident throughout
\nthe world, whether it is lead in petrol or a chemical spill from a factory, or drinking-water
\ncontaminated by sewage.
\nSanitation. Good sanitation eliminates some diseases such as cholera and dysentery
\ncompletely, and where this breaks down gastrointestinal illnesses are quickly evident. In
\ncommunities lacking basic sanitation, threats to health will arise from the contamination of
\nwater supplies by human excrement.Geopolitical And Phenomenological Place Influence Essay
\nHousing. The lack of a home affects all aspects of health \u2013 shelter from the weather, an
\nenvironment to sustain a family, a place to feel safe. The availability and type of housing
\nwill reflect local history, culture, the economy and political climate, with a wide range of
\nhousing existing across Europe such as tents in the Negev desert, tower blocks in cities,
\nnew housing estates, private housing, refugee camps and hostels. The type, quality and
\nsuitability of housing will have an important affect on health. Look for factors such as
\n9
\novercrowding, dampness and poor heating, as these are significant factors affecting health.
\nAlso consider how far homes are from work, pharmacies, schools and shops.
\nTransport. Transport systems are important to record, as they can influence people\u2019s access
\nto services, social support networks and employment. Transport may also have an impact
\non health through accidents, noise and air pollution.
\nSocial cohesion
\nSocial support is essential for the well being of a community. There are a number of
\nelements that need to be taken into consideration when describing the extent of social
\ncohesion in a community.
\nNetworks. Family and friendship networks provide people with the emotional support that
\nis fundamental to wellbeing. Social networks can be hard to describe and quantify. The best
\nway is to ask local people. It may be possible for them to describe social networks through
\nflow diagrams, maps, drawings, stories and drama. Match the methods you choose with
\nlocal customs and educational experience.
\nMigration. Migration causes disruption to a population, as large numbers of people move
\nlocation. It is often the younger working-age population who emigrate, and this is a loss to
\nthe population left behind while a gain to the community they move to. Migration of
\nworkers may be daily, weekly or longer. Population movements can be traumatic owing to
\nthe upheaval caused, especially if forced by armed conflict, threat of discrimination or
\nsevere economic necessity. Immigrants are usually poorer than the native population and
\nmay not be able to communicate because of language difficulties. They may also be
\nmarginalized socially, culturally and economically as a result of racism. All these
\nexperiences will significantly affect the health of a community.
\nMarginal groups. Marginal groups are outside the dominant community, yet may form a
\ndistinct population themselves. Some groups, such as religious sects, travellers and gypsies
\nmay choose to remain outside mainstream society. Others, such as the homeless, may be
\nforced into that position. Access to health care is often more difficult for both these groups,
\nwho may have greater need for services.
\nPleasure and leisure. The opportunities for non-work social activities are signposts that can
\nbe used to indicate the extent of social cohesion and support in a community. Such
\nactivities reinforce a community\u2019s identity and the emotional wellbeing of individuals.
\nDestabilizing factors
\nWar, economic recession and natural disasters such as earthquakes, floods or drought affect
\nhealth directly through their impact on mortality, disease patterns and lifestyle change.Geopolitical And Phenomenological Place Influence Essay
\nThey also affect health indirectly by reducing the resources available for health services,
\nincreasing poverty and lowering the social and economic wellbeing of a population. They
\nmay radically lower population numbers and increase fear and mental ill health. For these
\nreasons a record of destabilizing factors and their effects need to be included in a
\ncommunity health needs assessment profile.
\n10
\nResources, formal and informal
\nAll communities have existing resources and assets with which they respond to the needs of
\nindividuals, families or social groups. These resources may be formal services or informal
\nnetworks. It is important to assess the extent of both types of resource as part of the profile
\ninformation. It is too easy to focus on the problems and needs of a community; by ignoring
\nthe strengths there is a danger that existing assets can be undermined.
\nInformal. Families deliver the greatest part of all care services in the community. In these
\ncircumstances, the burden of care normally falls primarily on women and can have
\nsignificant effects on their health status. State private and voluntary systems of care to a
\ngreater or lesser degree supplement the family or fill in where no family network exists.
\nThere may be a comprehensive welfare system or a patchwork system of charitable and
\nvoluntary organizations.
\nFormal. Formal services can be provided at a variety of levels and by many agencies. A
\nhealth profile should assess how effective they are and how much of the population has
\nbeen reached. How accessible are services to those without transport or who are disabled?
\nThese will include both health services and those provided by other sectors that have an
\nimpact on health. For example, WHO has highlighted links between women\u2019s literacy and
\nimprovements in family health, demonstrating that educational resources in a community
\nare an important resource for health (Rifkin 1990). Many political and religious
\norganizations also have resources that communities use to provide economic Helpance and
\nhealth and social care.
\nCurrent nursing work
\nThe nursing work within the local community, either caring for the sick or maintaining the
\nhealth of the well population, will be an important source of health information. By
\ncompiling the information contained in your nursing records you can gain additional insight
\ninto the current health status of the community. The following are questions you may like
\nto ask yourself in relation to the community you work with.
\nWhat illnesses do I see most of?
\nWhat problems occupy most of my time?
\nDo people I meet see themselves as sick?
\nWhat do people tell me about their worries and health?
\nWhat nursing interventions am I using and how well do they work?
\nHow many people are using the nursing services?
\nAre they from across all sections of the community?
\nDo I see those whose needs are greatest?
\nWhat changes have I seen take place in the community and in the services I
\nprovide?
\n11
\nThe nursing information is important because it is up to date and comes directly from
\nindividuals and families.
\nLocal people\u2019s views of their health needs and health services
\nA central part of health needs assessment is gathering information on local people\u2019s views
\nof their health needs and resources. Involving local people will ensure that any service
\ndeveloped will be based on need and be more likely to be acceptable to the population.
\nThere will always be a great deal of expertise and knowledge to draw on among the local
\npopulation, in particular on what assets exist, the factors that influence their health, what is
\nmost important, local health beliefs and solutions to problems.
\nIt is important that people are able to describe health problems and solutions in their own
\nterms. This may involve using less conventional methods such as photographs, drawings or
\npersonal stories. Be flexible and ask the community which methods are most suitable. The
\ncommunity view or perspective is important to include, and involving local people initiates
\ntheir involvement and participation in improving the health of their own community.
\nLocal and national priorities
\nNational priorities are often set by governments and influenced by the political and
\neconomic agenda. Local priorities will reflect national priorities as well as issues identified
\nby local groups, practitioners and communities. When undertaking a needs assessment you
\nwill need to discover what these priorities are in relation to health. Sometimes there can be
\na conflict between the national top-down agenda and the needs identified locally. Geopolitical And Phenomenological Place Influence Essay
\n12
\nSection Two: How do you find out?
\nSection One described the type of health information you may need in order to identify
\nhealth needs; the next stage is to collect this information. The easiest way to begin to create
\nyour population health profile is to assemble the information that already exists. You may
\nlike to use the form at the end of this section to record the information, and the source, as
\nyou acquire it. The missing parts will then be clearer and you can then collect your own
\ninformation to complete the profile.
\nThis section provides simple guidelines on how to collect information. As information
\nsources and types are so variable across Europe, it is only possible to give general advice
\non data collection. For more detailed help and support seek out local experts, such as other
\nnurses, public health specialists, health researchers, and health service planners and
\nproviders.
\nDescribing the community
\nMaps are good pictorial representations of a community\u2019s geography and are usually easy
\nto obtain. Sometimes local people can draw their own map, this can also be useful in
\nfinding out what they think is important in the community as well as encouraging
\nownership of the needs assessment. The local administrative department should have access
\nto census information, including births and deaths. If this is not available it may be possible
\nto trace it through a local registration scheme. It will help to talk to people responsible for
\ndata collection, as they can reveal the strengths and weaknesses of the information, such as
\nwhether it includes all births and deaths, or the accuracy of the census information.
\nLocal views
\nThese can be obtained using a variety of methods that allow for different perspectives.
\nApproaching local individuals or groups
\nTry to ensure that a wide range of people are included, particularly minority groups, and try
\nto have a schedule of topic (sample nursing essay examples by the best nursing assignment writing service) areas for each group to consider. The key to accessing these
\ngroups is often through community leaders. Try to involve such people in the process as
\nmuch as possible. Local individuals or groups, such as social clubs or self-help groups, also
\nprovide a good source of information. A structured approach such as questionnaires or
\nsurveys is useful when compiling this information \u2013 it will be more comprehensive and
\nreliable. Appendix 3 gives a suggested interview schedule. If literacy is a problem, use
\npictures, flow charts, diagrams or taped interviews. Another approach is to ask local people
\nto represent their view of local health issues through drawings or photographs.
\nProfessional views
\nOther professionals working locally, such as teachers, dentists, pharmacists,
\nsocial\/community workers and religious leaders will also have views to give. Again, if the
\nsame methodology is used to collect the information it will make it easier to understand and
\nanalyse.
\n13
\nLocal surveys
\nSurveys of local opinion may already have been done by statutory or voluntary agencies.
\nFor example, a disease-focused support group may have mapped the extent of the illness
\nand care provision. Disease registers used for chronic illnesses, such as diabetes, can
\nprovide a database when conducting patient-based surveys, if confidentiality can be
\nassured. It is important to remember when collecting local views that as far as possible the
\nsample should reflect all of the population, and it may be necessary to seek out minority
\ngroups to find out about their concerns. This is also a good way of establishing contacts
\nwith a local community, and involving them in health care decision-making and public
\nhealth programmes.Geopolitical And Phenomenological Place Influence Essay
\nNewspaper reports
\nThese are easily accessible and can show current issues of concern.
\nMeasures of health and of health inequalities
\nTo obtain a full picture of health, information about health should come from a variety of
\nsources. A public health department is a good place to begin. This may be national or local.
\nSome have very detailed information covering diseases, health service use and inequality in
\nservice provision, as well as mortality and morbidity rates. This information should also
\ncontain some analysis of national, regional and local information, providing a comparative
\npicture. If it is not possible for you to obtain all the information you require, identify the
\ngap and move on to collect what is available. Local health and social care managers may
\nkeep information for administrative purposes. However, this may be service-orientated
\nrather than people-focused, providing information on services rather than health.
\nNevertheless, proxy measures like these are useful in the absence of other data.
\nGovernment departments are valuable sources of data regarding social and economic
\nstructures in the local community. Wherever there is a tax collection system there should be
\ninformation about income distribution and wealth. Planning departments provide
\ninformation about housing and public amenities, industry and local hazards. Welfare
\nproviders may collect information about the recipients of their services and these are
\nusually specific to a group of people. This does not just apply to government agencies but
\nalso to charities and private agencies that provide services.
\nWhen looking at a small population do not rely too much on quantitative data as the
\nnumbers will be too small for meaningful comparisons. When in doubt seek the advice of
\nexperts in epidemiology.<\/p>\n
Nursing information
\nThis will be a significant section of any community health needs assessment that the nurse
\ncompiles. You can also draw on information from other members of the team.
\nNursing knowledge
\nThis is made up of three major strands.
\n14
\nObservations. Good observation is fundamental to all nursing assessments. It is a baseline
\nfor assessing the state of people\u2019s health and their progress. This information should not be
\ndifficult to obtain. At community level observation involves an informal nursing
\nassessment of the wellbeing of the community. Simply walk in the local area and ask
\nyourself the following questions:
\nWhat am I seeing?
\nWhat can I hear and smell?
\nWhat, if anything, is missing?
\nWhat is this telling me?
\nRecord the observations made.
\nInterviews and questionnaires. If any piece of information is missing, it may be necessary
\nto conduct a small piece of research yourself in order to obtain it. Questionnaires can be
\nused on a large scale to investigate a specific aspect of a community\u2019s health status, such as
\nthe spread of a disease, or exposure to particular risks or health damaging behaviour such as
\nsmoking. Interviews are generally used to give deeper insight into why or how conditions
\nor illnesses affect people.
\nCasework information. This is the information contained in nursing records. It may relate to
\ndisease patterns, wellbeing, social behaviour, uptake of services or social characteristics.Geopolitical And Phenomenological Place Influence Essay
\nThis may only relate to a small section of the community or group, or it may be
\nrepresentational of a larger population. The nurse should make clear the relationship of
\nher\/his client group to the wider community. This can provide focused and detailed
\nknowledge that is extremely relevant in identifying health needs.
\nThe family health assessment
\nThis is a nursing tool with three aims:
\nto assess family health needs in partnership with the family;
\nto enable the family to identify the services they need; and
\nto gain information for assessing need at a community level.
\nAn example of a family health assessment tool is given in Appendix 4.
\nFamilies\u2019 perceptions of health tend to differ from those of health professionals. Many
\npeople consider themselves healthy, even with chronic conditions, until there is a problem.
\nThe family health assessment covers physical, social, emotional and environmental health
\nand is completed by the family members themselves. The outcomes of the assessment are
\ndiscussed by the family and the nurse, and actions are agreed jointly.
\nA family health assessment made in partnership with a nurse can be empowering for a family.
\nIt can give them the means by which to demand or refuse services. Families have the right
\nto make choices and this should influence local service provision. The information that
\nfamilies provide about their community at micro level is of good quality and can build into
\nan overall picture of the community if a sufficient number of assessments are completed.
\n15
\nProfile information
\n1. Characteristics of the population
\nGeography
\nNumbers
\nAge distribution
\nGender distribution
\nEthnicity and religion
\nPopulation trends
\nLanguage and literacy
\n2. Health status of the population
\nMeasures of health
\n16
\n3. Local factors affecting health (positive and negative)
\nWork and employment
\nPoverty and incomes
\nEnvironment
\nSocial cohesion
\nDestabilizing factors
\nResources, formal and informal
\n4. Current nursing work
\n5. Local people\u2019s views of their health needs and health services
\n6. Local and national priorities
\n17
\nSection Three: What to do with the information
\nA community health needs assessment is incomplete if nothing is done after the
\ninformation has been collected. It must be analysed and used to plan, implement and
\nevaluate health services. The process is cyclical and should be repeated, with the
\ninformation updated so that it continues to reflect the needs of local people.Geopolitical And Phenomenological Place Influence Essay
\nSection Two enabled you to collect the information you need to give you insight into the
\nhealth needs of the community. Section Three will help you to analyse the information to
\nidentify the key health issues and plan actions to address them. This work, like all other
\nparts of the process, should be undertaken collaboratively if at all possible. This would
\nideally involve a group of people working together, but could include one person
\nundertaking the analysis and then consulting with others about the outcome, gaining their
\nviews and interpretations. Feedback can be given in many ways: through the local media,
\nby attending local groups, by circulating a written report, or from a newsletter, videotape or
\naudiotape summary. This collaboration acknowledges local people\u2019s contribution and
\nencourages their continued participation.
\nWhat is the information telling you?
\nThe way to approach the task of analysis is firstly to read the collected information as a
\nwhole and note the obvious. What are the issues that \u201cjump off the page\u201d? To make sense
\nof the information you have acquired you need to:
\ncompare your population with a larger group to ascertain whether a health issue or
\ndisease rate is higher or lower than expected;
\ncompare current information with that collected in previous years to identify
\ntrends over time;
\nidentify significant gaps in the information;
\ncompare and contrast different types of information e.g. statistics, client and
\nprofessional views, surveys and questionnaires; and
\nlook for positive features as well as problems; even the most disadvantaged
\ncommunities have strengths that can form the building blocks for change.
\nIt is important to seek the help and views of others as you undertake this process, ensuring
\nthat your personal views have not distorted the analysis. At the end summarize and make a
\nlist of the health issues you identify, as these will be the main conclusions to be
\ncommunicated to others.
\nDeciding on priorities
\nBy now you will have identified a number of health needs in the community. But resources
\nare always limited and it will be necessary to determine which needs should be a priority.
\nIn order to reach agreement this process should be undertaken with others.
\n18
\nThere are a number of considerations that will help you decide which needs should be a
\npriority. Try to answer the following questions in relation to each health need or issue you
\nhave identified.
\nHow many people are affected?
\nFor example, coronary heart disease is a major issue in health care in the western world,
\nbecause it is one of the main causes of death and disease. Its significance is due to the
\nnumber of people who die prematurely from coronary heart disease and the number of
\npeople affected. Infectious diseases such as tuberculosis can have a profound effect because
\nof the potential number of people who could be affected.
\nWhat is this information telling you about equity?
\nAre there disadvantaged groups with high needs for care? Are some people less able to
\naccess services? Are those whose needs are greatest receiving the services they need?
\nWhat is the impact on people\u2019s lives?
\nSome health needs may only affect a small number of people but the impact for those
\npeople may be so severe that a response is required. Significant minority groups, such as
\nthose with learning difficulties or with rare chronic diseases, would fall into this category.
\nMinority groups such as the homeless or refugees, who have significantly greater health
\nrisks than average, should also be highlighted.
\nAre there appropriate and effective interventions?
\nEffectiveness means that an intervention does what it intended to do. Many health gains have
\nbeen delivered through improvements in the standard of living, such as nutrition and
\nsanitation, and not directly through health services. It may be necessary to look beyond
\nhealth services when planning action to address a health problem. Where a health intervention
\nis planned it is important to know that it will improve health. Sometimes you will find that
\nresearch has been reviewed and summarized by others; alternatively it may be necessary for
\nyou to review research findings yourself or consult others for specialist expertise.
\nHealth care interventions should not only be effective but should also be targeted at the
\nright people and be acceptable to local people. It is necessary to think about the cost as well
\n\u2013 any use of resources has to be justified in terms of cost and benefits to health.
\nAre the services adequate?Geopolitical And Phenomenological Place Influence Essay
\nAsking whether services are adequate is a key question in community health needs
\nassessment. Analysis of the information may highlight a lack of services or duplication in
\nterms of treatment, prevention or services for a particular age or disease group. The
\npopulation profile might describe a growing elderly population but the services might not
\nhave developed in response to this change.
\n19
\nDoes the health need identified coincide with known priorities and strategies?
\nThe national and local priorities and health programmes will influence whether a local
\nhealth need will be acted on. It may be that action on an issue is already being taken as part
\nof a national strategy, or it may be that local action is required by such a strategy.
\nIs the expertise and training available?
\nThere may be people working or living in the community who have skills and knowledge
\nthat are not being used to the full. Skills and knowledge are just as much a resource as
\nbuildings and money, so knowing about these assets will help in deciding how to deal with
\nneeds raised through the assessment. For example, the \u201ccommunity mothers\u201d scheme in
\nDublin, Ireland, was developed following the identification of the need for parenting advice
\nand support. The skills and expertise of local mothers has been used to fill that need, i.e. an
\neffective local solution was found to a problem by utilizing local skills.
\nPlanning what to do
\nThe final and most important part of the community health needs assessment process is
\nplanning and implementing the actions that will address the priority health needs you have
\nidentified. The measure of a good assessment process will be the success or failure of the
\nactions taken to improve health. There are a number of important considerations to be taken
\ninto account when planning your interventions.
\nBeing creative
\nWhen devising your action plan, try to think widely and creatively about potential solutions
\nto the issues you are tackling. For example, if you wish to address the number of people
\nwith chronic diseases, you may need to consider not only their access to care, but also the
\nneeds of their informal carers. You may also need to think about their housing and
\neconomic needs and their access to local employment. The more people you involve in this
\nprocess, the greater the scope for potential solutions.
\nInvolving the community
\nA community health needs assessment belongs to the local community and those who work
\nin it. These people will want to have a say in the process of planning local services.
\nInvolving the community will ensure that plans are appropriate and that people are
\ncommitted to their implementation.
\nCollaboration
\nIt will often not be possible for a single agency or individual to bring about change on his
\nor her own. Work needs to be planned with others, agreeing who the key people are and
\ndeciding together what needs to be done and by when.
\nHealth promotion
\nWHO defines health promotion as \u201cthe process of enabling people to increase control over
\nand to improve their health\u201d (WHO 1985). It is a model of empowerment for individuals
\nand communities. Health promotion covers a range of activities:
\n20
\ncreating healthy public policies
\nbuilding supportive environments
\nstrengthening community action
\ndeveloping personal skills
\nreorganizing health services
\naddressing inequalities.
\nIf undertaken with local people, community health needs assessment can be a way of
\npractising health promotion. You might like to check whether your proposed actions are
\nmeeting the range of activities noted above.Geopolitical And Phenomenological Place Influence Essay
\nPrevention
\nActions to improve health will include both treatment and care of those who are ill, as well
\nas activities that will keep the community healthy. Strategies for preventing ill health are
\nusually put into the following three categories.
\nPrimary prevention aims to stop the onset of a disease or a condition. Examples are
\npregnancies prevented by a contraception programme or coronary heart disease prevented
\nby smoking cessation work.
\nSecondary prevention works by early detection and treatment of a disease or condition,
\nusually through screening programmes. Examples are screening women for cervical cancer
\nand the early treatment of first symptoms.
\nTertiary prevention is the management of diseases to control symptoms or prevent
\nrecurrence of a disease or condition, for example, rehabilitation programmes.
\nMeasuring success
\nWhatever the action plan agreed, it is necessary to monitor and record the changes that are
\ntaking place and evaluate successes and failures. These are a few simple guidelines that
\nshould help. Be clear about recording:
\nwhere you are now (baseline measures)
\nwhere you are going (aim and objectives)
\nhow to get there (action plan)
\nhow you will know you have arrived (Assessment\/outcome measures).
\nAim for small, achievable, measurable goals, as this increases the chance of success.
\nMeasure your progress against them regularly. Share and celebrate your successes with
\nothers. Where plans are not having the desired effect, consider them again and consult with
\nothers to develop changes.
\n21
\nYou should now create your action plans. You might like to use the table provided at the
\nend of the section to record your agreed plans.
\nTaking action
\nYou should now put your plans into action. If the plans demand that you work differently in
\nthe future, think through with others how you will make this possible. Do you need further
\ntraining? Have you the authority to change your working practices, or do you need to agree
\nthis with others? The community health needs assessment will demonstrate the need for
\nchange, so do not be hesitant about raising the issue. Planning your work on the basis of
\nlocal health needs will ensure that you are using your skills and knowledge for the benefit
\nof the community.
\nRecord of action plans
\nHEALTH
\nPROBLEM TO
\nBE
\nADDRESSED
\nOBJECTIVES ACTION TO BE
\nTAKEN
\nWHO
\nWILL DO
\nIT?
\nTIME
\nSCALE
\nAssessment
\nMEASURES
\n22
\nAppendix 1: Community development
\nCommunity development is central to WHO\u2019s health for all principles and is reiterated in
\nthe HEALTH21 policy framework (WHO 1999), i.e. equity, community participation,
\nempowerment, collaborative working and local primary health services. It involves working
\nalongside local people to find ways of addressing the issues that they see as affecting their
\nhealth, by generating local partnerships and action. The health worker establishes a basis of
\nequality and collaboration in relationship to others, and works with a community when
\nagreeing plans for local health care.Geopolitical And Phenomenological Place Influence Essay
\nThis approach works best in small defined areas such as villages or housing estates. It is
\nimportant that the whole community is involved or represented. The priority health issues
\nidentified by the community may not coincide with those of the professionals, and it can be
\ndifficult to develop agreement. Nevertheless, if a community becomes involved in actions
\nto protect the health of its own people, this will be a powerful force for change.
\nA community development approach, building up trusting relationships and developing the
\nconfidence of local people, can take time. For the nurse this can have exciting outcomes as
\nshe\/he sees the growing potential of the community to address its own health needs.
\n23
\nAppendix 2: Health measures
\nBirth rate, i.e. number of live births for a population. The formula for calculating this is:
\nAll live births in an area during the year x 1000
\nTotal population in the area at mid-year
\nMortality rates are usually presented in one of three ways:
\nCrude mortality rates, i.e. number of deaths in an entire population. The formula
\nfor calculating this is:
\nAll deaths during a specified period____ \u00d7 k (usually1000 or 10 000)
\nTotal population at mid-point of the period
\nSpecific mortality rates, i.e. for a particular group of the population (e.g.
\nchildren). The formula for calculating this is:
\nAll deaths in the group in a specified period____ \u00d7 k (usually1000 or 10 000)
\nTotal group population at mid-point of the period
\nStandardized mortality ratios (SMRs), i.e. where the age and sex structure of the
\npopulation has been taken account of (standardized) so that rates can be
\ncompared between geographical areas. The formula for calculating this is:
\nObserved number of deaths \u00d7 100
\nExpected number of deaths
\nAn SMR of 100 indicates that the observed number of deaths is the same as the expected
\nnumber. An SMR of more than 100 indicates a higher than expected number of deaths, and
\nwhen less than 100 a lower than expected number is indicated. SMRs are especially used in
\ninternational comparison Geopolitical And Phenomenological Place Influence Essay<\/p>\n","protected":false},"excerpt":{"rendered":"
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