Chapter Six: Community Health Assessment and Evaluation
Practical Application: Book Activity
Practical Application
Setting the Scene
Local health departments help provide a safe and healthy environment for their communities. They provide services such as
- Planning for emergencies
- Securing resources for disasters, such as first aid equipment and vaccines
- Administering vaccinations
- Managing local disease outbreaks
- Inspecting restaurants, grocery schools, and other community resources for food safety
- Implementing and supporting interventions for drug overdoses
They often work with community partners to ensure a base level of health for the communities they serve (National Association of County and City Health Officials, 2017).
Think About It.
Imagine that you are a new member of your local health department. Before you meet with community members, you decide to gather some additional data to help you draw a mental picture of the community. You will need to understand the range of social determinants of health, built environment, and the community’s perception of their health and well being.
- Describe the benefits, disadvantages, and considerations for each of the following types of assessments.
- Census data for the community
- Health impact assessment
- Windshield survey
- MAPP survey
- Hospital needs assessment ( published every 3 years by non-profit hospitals.)
- Which assessment type (or combination of assessments) would you pick to help you become quickly familiar with your new community and why?
- What information will you need to complete a windshield survey?
Practical Application: Additional Guidance
Exercise Title
Community Health Assessment and Evaluation Application Practice Instructor Guidelines
Objective
- Discuss how community health assessments aid in promoting public health and addressing community needs.
- Familiarize students with various assessment methods used to evaluate community health.
- Develop critical thinking skills by analyzing community data and identifying health priorities.
Preparing for the Exercise
- Review the Chapter Material: Read Chapter Six: Community Health Assessment and Evaluation Practice.
- Gather Resources: Collect relevant materials, including textbooks, articles, and online resources related to community health assessment
Exercise Components
- Introduction (15 minutes):
- Briefly introduce the purpose of the exercise and its relevance to nursing practice.
- Describe the community as patient.
- Discuss the role of community health assessments in improving population health.
- Types of Assessments (30 minutes):
- Present the following assessment methods:
- Census Data: Explain the benefits (comprehensive demographic information) and disadvantages (infrequent updates, lack of context) of using census data.
- Health Impact Assessment (HIA): Discuss how HIA evaluates potential health effects of policies, projects, or programs.
- Windshield Survey: Describe the process of observing the community by driving or walking through it. Highlight its advantages (direct observation, community engagement) and limitations (subjectivity).
- Mobilizing for Action through Planning and Partnerships (MAPP) Survey: Explore MAPP as a community-driven approach to health assessment.
- Hospital Needs Assessment: Discuss its purpose (identifying health service gaps) and the role of non-profit hospitals in conducting it.
- Present the following assessment methods:
- Group Activity (45 minutes):
- Divide students into groups.
- Assign each group a specific assessment type.
- Provide case scenarios related to a community.
- Ask students to analyze data, identify community needs, and propose interventions based on their assigned assessment method.
- Discussion and Reflection (20 minutes):
- Have groups share their findings and recommendations.
- Discuss the strengths and limitations of each assessment type.
- Reflect on the challenges of assessing a community.
Evaluation and Assessment
- Group Presentation: Assess students’ understanding of assessment methods, critical thinking skills, and ability to apply knowledge.
- Individual Reflection: Ask students to write a brief reflection on the exercise, highlighting key takeaways and areas for improvement.
Integration into Curriculum
- Alignment with Course Objectives: Ensure that the exercise aligns with course objectives related to public health.
- Sequencing: Determine the appropriate timing and sequencing of the exercise within the course curriculum to complement other content and activities.
- Integration of Theory and Practice:
- Encourage students to explore real-world community health data and engage with local health departments.
- Include assessment tools, like the windshield survey, into clinical requirements for students to complete in the communities where they are assigned.
Resources and Support
- Learning Resources: Provide students with access to relevant literature, articles, and resources on community health assessment, including:
- Community Health Assessment Toolkit: Refer to the American Hospital Association’s toolkit for practical guidance1.
- CDC’s Community Health Assessment and Group Evaluation (CHANGE) Tool: Explore this resource for community health assessment.
- Local Health Department Reports: Access reports from local health departments to understand community needs and priorities.
- Faculty Support: Offer guidance, feedback, and support to students as they engage in the exercise, addressing any questions or concerns they may have about the scenario or related topics.
Conclusion
By following these guidelines, nurse educators can create an activity which can help students identify which tools are best to use within their own communities of interest through comparing and contrasting community assessment tools.
Additional Activities
Role-playing/Communication Exercise
Scenario Title
Community Health Nurse Conducting a Health Assessment
Objective
To enhance communication skills and empathy in community health nurses while conducting health assessments.
Roles
- Community Health Nurse (CHN)
- Client/Patient
- Observer
Materials Needed
- Notepads and pens
- Mock health history forms
- Scenario cards with different client backgrounds and health conditions
Scenario Setup
- Set the Scene: Arrange a space that mimics a home or community health clinic.
- Distribute Roles: Assign participants to the roles of Community Health Nurse, Client/Patient, and Observer. Rotate roles if time permits.
Role-Playing Activity
- Scenario Setup
- Provide each participant with a scenario card that includes a brief background about the client/patient. Scenarios should cover various demographics, health conditions, and social situations.
- Example scenarios:
- Elderly patient with diabetes living alone.
- Young single mother with a newborn.
- Middle-aged individual recently diagnosed with hypertension.
- Role-Playing the Assessment
- Community Health Nurse:
- Introduce yourself and explain the purpose of the visit.
- Use open-ended questions to gather comprehensive health information.
- Display active listening by nodding, maintaining eye contact, and summarizing what the patient says.
- Show empathy and understanding, especially when discussing sensitive topics.
- Encourage the patient to ask questions and express concerns.
- Client/Patient:
- Provide detailed responses based on the scenario card.
- Exhibit realistic behavior and emotions relevant to the scenario.
- Ask questions and express any concerns or fears.
- Observer:
- Take notes on the communication skills used by the nurse.
- Observe body language, tone of voice, and the effectiveness of questions.
- Prepare to give constructive feedback on strengths and areas for improvement.
- Community Health Nurse:
- Feedback
- After the role-play, have the Observer provide feedback to the Community Health Nurse.
- Discuss what went well and what could be improved.
- Rotate roles and repeat the activity with a new scenario to allow each participant to practice and observe.
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- The importance of cultural sensitivity and understanding the patient’s background.
- Techniques for building rapport and trust with patients.
- How to handle difficult conversations and emotions during assessments.
- Strategies for ensuring clear and effective communication.
Reflective Practice
This activity could occur on a discussion board or by uploading a video using Flip or Canvas Studio.
As a community health nurse, how would you evaluate the overall health of a community, and what key indicators would you focus on to determine areas that need improvement?
Interactive Module
Create an interactive escape room using Google Forms that challenges students to solve puzzles related to the chapter topic. These NCLEX-style questions can be a starting point.
- A community health nurse is assessing the overall health of a community. Which of the following data would provide the most comprehensive information about the community’s health status?
- Number of primary care physicians per capita
- Rates of high school graduation
- Prevalence of chronic diseases
- Availability of recreational facilities
- When evaluating the health needs of a community, a nurse considers social determinants of health. Which of the following is NOT typically considered a social determinant of health?
- Housing quality
- Employment status
- Individual genetic predisposition
- Educational attainment
- A nurse is developing a health improvement plan for a community with a high incidence of obesity. Which of the following strategies should be prioritized?
- Increasing the number of fast-food restaurants
- Implementing community exercise programs
- Reducing the cost of healthcare services
- Offering free dental check-ups
- During a community health assessment, a nurse finds a high rate of infant mortality. What is the most likely contributing factor to this finding?
- High prevalence of mental health issues
- Lack of prenatal care services
- High number of recreational facilities
- Low rates of chronic diseases
- A community health nurse is evaluating the effectiveness of a recently implemented vaccination program. Which outcome would best indicate the program’s success?
- Increase in the number of healthcare providers
- Decrease in the incidence of vaccine-preventable diseases
- Improvement in overall literacy rates
- Reduction in the average age of the community
Case Study: Evaluating Community Health
Background
A community health nurse, Bilal, is assigned to evaluate the health status of the town of Riverdale. Riverdale is a small town with a population of approximately 15,000 residents. It has a mix of urban and rural characteristics, with a diverse population that includes various age groups, ethnicities, and socioeconomic backgrounds. Recently, there have been concerns about increasing rates of chronic diseases and health disparities within the community.
Objectives
- Assess the overall health status of the Riverdale community.
- Identify key health indicators and social determinants impacting the community.
- Develop an action plan to address identified health issues.
- Engage community members and stakeholders in the health improvement process.
Part 1: Initial Assessment
Bilal begins his assessment by gathering data from various sources, including health records, community surveys, and interviews with local healthcare providers. He focuses on the following key health indicators:
- Prevalence of chronic diseases (diabetes, hypertension, heart disease)
- Infant mortality rates
- Immunization rates
- Access to healthcare services
- Rates of mental health issues
- Socioeconomic factors (income levels, education attainment, employment status)
- Environmental factors (housing quality, availability of recreational facilities)
Questions:
- What primary data sources should Bilal use to gather comprehensive information about the health status of Riverdale?
- Why is it important for Bilal to consider social determinants of health in his assessment?
- Which health indicators might suggest underlying health disparities within the community?
Part 2: Community Engagement
Bilal organizes a series of community forums and focus groups better to understand the community’s health needs and concerns. He invites residents, local leaders, healthcare providers, and representatives from non-profit organizations to participate.
During these forums, community members express concerns about the lack of accessible healthcare services, high rates of obesity, and limited mental health resources. They also highlight positive aspects of the community, such as strong social support networks and a commitment to improving public health.
Questions:
- What strategies can Bilal use to engage the community in the health assessment process effectively?
- How can Bilal ensure that the voices of marginalized and underserved populations are heard during these forums?
Part 3: Data Analysis and Identification of Key Issues
After collecting data and engaging with the community, Bilal analyzes the information to identify key health issues. He discovers the following:
- High prevalence of diabetes and hypertension, particularly among low-income residents.
- Infant mortality rates are above the national average.
- Low immunization rates in certain areas of the community.
- Significant mental health challenges, with limited access to mental health services.
- Socioeconomic disparities contribute to health inequities.
Questions:
- What steps should Bilal take to prioritize the identified health issues and develop an action plan?
- How can Bilal address both the immediate health needs and the long-term social determinants of health in Riverdale?
Part 4: Action Plan Development and Implementation
Bilal collaborates with local stakeholders to develop a comprehensive action plan aimed at improving the health of Riverdale residents. The plan includes initiatives such as:
- Establishing community-based health education programs focused on chronic disease prevention and management.
- Partnering with local healthcare providers to improve access to prenatal care and reduce infant mortality rates.
- Launching immunization campaigns to increase vaccination coverage.
- Expanding mental health services and providing training for healthcare providers.
- Addressing social determinants of health through policies and programs that promote economic stability, education, and housing quality.
Questions:
- What key elements should Bilal include in his action plan to ensure its effectiveness and sustainability?
- How can Bilal measure the success of the implemented health initiatives over time?
Part 5: Evaluation and Continuous Improvement
Bilal implements the action plan and periodically evaluates its impact on the community’s health. He collects new data, monitors health indicators, and gathers feedback from community members and stakeholders. Based on this information, he adjusts the plan as needed to address emerging health issues and ensure continuous improvement.
Questions:
- What methods can Bilal use to evaluate the effectiveness of the health initiatives and make necessary adjustments?
- How can Bilal foster a culture of continuous improvement in community health within Riverdale?
Simulation
Scenario
Evaluating Community Health
Overview
The town of Rivertown has a population of 20,000, diverse demographics, and varying socioeconomic statuses.
Objective
To provide nursing students the opportunity to evaluate the health of a community, identify key health issues, and develop strategies for improvement.
Roles
- Registered Nurse
- Residents
- Local Healthcare Providers
- Community Leaders
Materials Needed
- Community health data (pre-prepared handouts)
- Scenario cards for residents, healthcare providers, and community leaders
- Health assessment tools (mock surveys, interview guides)
- Notepads, pens, and clipboards
- Visual aids (charts, graphs)
- Meeting space set up to simulate a community hall or clinic
Simulation Outline
- Pre-Simulation Briefing
- Objective: Orient participants to the simulation, provide background information on Rivertown, and assign roles.
- Background on Rivertown:
- Population: 20,000
- Key issues: rising rates of obesity, high incidence of diabetes and hypertension, low immunization rates, and mental health challenges.
- Socioeconomic factors: 20% of the population lives below the poverty line, limited access to healthcare in rural areas.
- Roles Assignment:
- Registered Nurse: Conducts assessments, interacts with residents and stakeholders, and develops an action plan.
- Residents: Provide information based on scenario cards about their health and concerns.
- Local Healthcare Providers: Offer insights into health trends and challenges from a provider’s perspective.
- Community Leaders: Represent community interests, provide information about resources, and collaborate on solutions.
- Data Collection
- Objective: Gather health data and perspectives from the community.
- Activities:
- Surveys: RN distributes and collects surveys from residents.
- Interviews: RN conducts structured interviews with residents, healthcare providers, and community leaders.
- Observation: RN observes community facilities (clinics, recreational centers) and assesses their condition and accessibility.
- Tools:
- Mock health surveys with questions about chronic conditions, lifestyle habits, access to healthcare, and social determinants.
- Interview guides with questions tailored to each group (residents, healthcare providers, community leaders).
- Community Engagement Forum
- Objective: Engage the community in a discussion about their health needs and concerns.
- Activities:
- Town Hall Meeting: RN facilitates a meeting where residents, healthcare providers, and community leaders discuss health issues.
- Focus Groups: Small group discussions on specific topics like chronic disease management, mental health, and preventive care.
- Discussion Points:
- Key health concerns identified from the surveys and interviews.
- Barriers to accessing healthcare.
- Community resources and support systems.
- Suggestions for health improvement initiatives.
- Data Analysis and Action Plan Development
- Objective: Analyze collected data and develop a comprehensive action plan.
- Activities:
- Data Analysis: RN reviews survey results, interview notes, and observations to identify key health issues and trends.
- Prioritization: RN prioritizes health issues based on severity, prevalence, and community input.
- Action Plan: RN collaborates with healthcare providers and community leaders to develop a plan that addresses identified issues.
- Action Plan Components:
- Health education programs on chronic disease prevention and management.
- Initiatives to improve access to healthcare, such as mobile clinics.
- Community outreach to increase immunization rates.
- Mental health support services and resources.
- Implementation and Evaluation
- Objective: Implement the action plan and evaluate its effectiveness.
- Activities:
- Implementation: RN works with community partners to roll out health initiatives.
- Monitoring: Regularly monitor health indicators and community feedback.
- Evaluation: Assess the impact of initiatives on community health and make adjustments as needed.
- Tools:
- Progress reports with metrics on health improvements.
- Follow-up surveys and interviews to gather feedback.
- Evaluation meetings with stakeholders to review outcomes and plan next steps.
Debriefing and Feedback
After the simulation, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- What were the most significant health issues identified in Rivertown?
- How effective were the community engagement strategies?
- What challenges did you face in developing and implementing the action plan?
- How would you improve the process in a real-world setting?
Competency Assessment
Activity
Create an Action Plan
Demonstration
Outline a plan for addressing something that impacts community health, including preventive measures, education campaigns, and resource allocation.
Clinical Activities/Opportunities
- School Health Programs:
- Implement health education programs in schools focusing on nutrition, physical activity, and mental health.
- Conduct screenings for vision, hearing, and general wellness.
- Health Promotion Campaigns:
- Develop and implement campaigns to promote healthy behaviors and preventive care.
- Utilize social media, local media, and community events to spread awareness.