Additional Material for Study, Review, and Further Exploration

Assessment

To establish a professional relationship with the chosen aggregate, a community health nurse must first gain entry into the group. Good communication skills are essential to make a positive first impression. The nurse should make an appointment with the group leaders to set up the first meeting.

The nurse must initially clarify his or her position, organizational affiliation, knowledge, and skills. The nurse should also clarify mutual expectations and available times. Once entry is established, the nurse continues negotiation to maintain a mutually beneficial relationship.

Meeting with the aggregate on a regular basis will allow the nurse to make an in-depth assessment. Determining sociodemographic characteristics (e.g., distribution of age, sex, and race) may help the nurse ascertain health needs and develop appropriate intervention methods. For example, adolescents need information regarding nutrition, abuse of drugs and alcohol, and relationships with the opposite sex. They usually do not enjoy lectures in a classroom environment, but the nurse must possess skills to initiate small-group involvement and participation. An adult group’s average educational level will affect the group’s knowledge base and its comfort with formal versus informal learning settings. The nurse may find it more difficult to coordinate time and energy commitments if an organization is the focus group, because the aggregate members may be more diverse.

The nurse may gather information about sociodemographic characteristics from a variety of sources. These sources include observing the aggregate, consulting with other aggregate workers (e.g., the factory or school nurse, a Head Start teacher, or the resident manager of a high-rise senior-citizen apartment building), reviewing available records or charts, interviewing members of the aggregate (i.e., verbally or via a short questionnaire), and interviewing a key informant. A key informant is a formal or informal leader in the community who provides data that is informed by his or her personal knowledge and experience with the community.

In assessing the aggregate’s health status, the nurse must consider both the positive and negative factors. Unemployment or the presence of disease may suggest specific health problems, but low rates of absenteeism at work or school may suggest a need to focus more on preventive interventions. The specific aggregate determines the appropriate health status measures. Immunization levels are an important index for children, but nurses rarely collect this information for adults. However, the nurse should consider the need for influenza and/or pneumonia vaccines with the elderly. Similarly, the nurse would expect a lower incidence of chronic disease among children, whereas the elderly have higher rates of long-term morbidity and mortality.

The aggregate’s suprasystem may facilitate or impede health status. Different organizations and communities provide various resources and services to their members. Some are obviously health related, such as the presence or absence of hospitals, clinics, private practitioners, emergency facilities, health centers, home health agencies, and health departments. Support services and facilities such as group meal sites or Meals on Wheels (MOW) for the elderly and recreational facilities and programs for children, adolescents, and adults are also important. Transportation availability, reimbursement mechanisms or sliding-scale fees, and community-based volunteer groups may determine the use of services. An assessment of these factors requires researching public records (e.g., town halls, telephone directories, and community services directories) and interviewing health professionals, volunteers, and key informants (i.e., someone who is familiar with the community) in the community. The nurse should augment existing resources or create a new service rather than duplicating what is already available to the aggregate.

A literature review is an important means of comparing the aggregate with the norm. For example, children in a Head Start setting, day care center, or elementary school may exhibit a high rate of upper respiratory tract infections during the winter. The nurse should review the pediatric literature and determine the normal incidence for this age range in group environments. Further, the nurse should research potential problems in an especially healthy aggregate (e.g., developmental stresses for adolescents or work or family stresses for adults) or determine whether a factory’s experience with work-related injury is within an average range. Comparing the foregoing assessment with research reports, statistics, and health information will help determine and prioritize the aggregate’s health problems and needs.

The last phase of the initial assessment is identifying and prioritizing the specific aggregate’s health problems and needs. This phase should relate directly to the assessment and the literature review and should include a comparative analysis of the two. Most important, this step should reflect the aggregate’s perceptions of need. Depending on the aggregate, the nurse may consult the aggregate members directly or interview others who work with the aggregate (e.g., a Head Start teacher). Interventions are seldom successful if the nurse omits or ignores the clients’ input.

Planning

Again, the nurse should determine which problems or needs require intervention in conjunction with the aggregate’s perception of its health problems and needs, and based on the outcomes of prioritization. Then the nurse must identify the desired outcome or ultimate goal of the intervention. For example, the nurse should determine whether to increase the aggregate’s knowledge level and whether an intervention will cause a change in health behavior. It is important to have specific and measurable goals and desired outcomes. This will facilitate planning the nursing interventions and determining the evaluation process.

Planning interventions is a multistep process. First, the nurse must determine the intervention levels (e.g., subsystem, aggregate system, and/or suprasystem). A system is a set of interacting and interdependent parts (subsystems), organized as a whole with a specific purpose. Just as the human body can be viewed as a set of interacting subsystems (e.g., circulatory, neurological, integumentary), a family, a worksite, or a senior high-rise can also be viewed as a system. Each system then interacts with, and is further influenced by, its physical and social environment, or suprasystem (for example, the larger community).

Second, the nurse should plan interventions for each system level, which may center on the primary, secondary, or tertiary levels of prevention. These levels apply to aggregates, communities, and individuals. Primary prevention consists of health promotion and activities that protect the client from illness or dysfunction. Secondary prevention includes early diagnosis and treatment to reduce the duration and severity of disease or dysfunction. Tertiary prevention applies to irreversible disability or damage and aims to rehabilitate and restore an optimal level of functioning. Plans should include goals and activities that reflect the identified problem’s prevention level.

Third, the nurse should validate the practicality of the planned interventions according to available personal as well as aggregate and suprasystem resources. Although teaching is often a major component of community health nursing, the nurse should consider other potential forms of intervention (e.g., personal counseling, policy change, or community service development). Input from other disciplines or community agencies may also be helpful. Finally, the nurse should coordinate the planned interventions with the aggregate’s input to maximize participation.