Assessing and addressing need in the community

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Assessing and addressing need in the community



CHAPTER AIMS



• To examine how ‘need’ is assessed within the community and to explore the concept of ‘health needs assessment’


• To explore the different issues to be addressed in the individual assessment of care including the use of a person-centred approach


• To discuss the role of the nurse in promoting health and wellbeing and what students can learn in a community placement



Health needs assessment: getting to know your community


To enable primary care staff to understand and plan appropriate services to meet the healthcare needs of the practice population, several sources of data are gathered. Data related to health needs normally includes aspects of the community which can affect health such as housing, education, socioeconomic status and unemployment/employment statistics. Associations have been identified between deprivation and behavioural factors which affect health, for example people who are economically inactive and in lower socioeconomic groups are more likely to be cigarette smokers and live in areas of deprivation (Robinson & Harris 2011). Deprived areas also have higher levels of death due to coronary heart disease (Naylor et al 2012). The term ‘community profile’ is sometimes used to describe specific aspects of the practice locality and normally includes issues related to the specific characteristics of the population (the demography), local amenities and public services, employment, transport. Data related to the specific incidence and pattern of disease which relates to the local pattern of need is also significant when planning appropriate services.



Activity


In discussion with your mentor, select one specific health issue which is significant within your specific practice placement population and compile information from different sources on this topic, which would help a new community nurse coming to work within the locality.


You may wish to refer to:



You may also like to use the links below, to see how comprehensive and easily accessible information about the community can be. Both are excellent resources for finding out about public health and needs of populations.


Look at ‘The Network of Public Health Observatories’ website, which produces information, data and intelligence on people’ health and healthcare practitioners across the UK and has expertise in utilising data and information into meaningful health intelligence: www.apho.org.uk.


There is also a European Public Health Observatory which has information on European Health Care systems and other countries worldwide: http://www.euro.who.int/en/who-we-are/partners/observatory.


Once you have gathered the information it is important that you then compile them into a folder, ensuring that sections are organised in a way that the information is easily accessible for you and others reading it. It is important to ensure that whatever you gather, there is a clear contents list and an evidence-based reference list. It may be that some of you are required to compile a community profile for an assignment or for meeting your personal and professional development goals. The health issue identified for the community profile can also be used to look at how that health need is managed in the community.



Assessing ‘need’ in the community


Health needs assessment could be considered equivalent to a clinical consultation when the doctor will take a medical history from the patient, collecting information that assists with a diagnosis of the person’s problems, which then helps to identify solutions. The health needs assessment process takes a medical history at a population level, collecting data, which helps to diagnose the population’s health problems and assist in the planning and implementation of services, which will help to meet the population’s problems.



Activity


Discuss with your mentor the advantages of using a health needs assessment approach and how this will enable the health and social care team to plan an integrated approach to meeting the health needs of the community population.


Health needs assessment provides an opportunity to evaluate the population’s health status, in order to understand the needs and priorities of the practice and local population (NICE 2009). This should assist in developing clear aims and objectives to design and develop services to meet the population’s needs. Ultimately, this process aims to improve the health of the practice and local population, targeting groups and specific population needs.



Activity




This type of information will be invaluable if you are undertaking a health profile project of the community where your practice placement is to be found. This can build onto the information already collected on the profile of the community.



Including service users in the assessment of health needs


Health needs assessment should also involve the gathering of data from a wide range of sources, which should also include service users, their families and carers. Depending on where you are in your programme of study, you will have varied interaction with families and carers of service users. It is important to remember that if a person (service user) in the community has a long-term health problem, that they probably know more about this and its management than the main healthcare professional. They are living with the health problem – an example of this is someone who has had diabetes (mellitus) since they were 8 years old and who is now 48 years old! Determining their health needs as they get older however, may involve their family and/or carer.



Activity


Try to find out the different ways in which healthcare practitioners within your community practice placement consult their practice population; you might like to ask your mentor and other members of the community team.


In some health centres, for example there is a patient/healthcare professional forum which meets every 2–3 months to discuss a range of matters, from resources available in the health centre, to access to GP appointments. Patient satisfaction surveys, focus groups, one-to-one interviews, public meetings and interviews with key leaders of specific services, are additional ways in which user involvement can be integrated within service development. Some of these local questionnaires can be linked to the work of the general practice nurse for example, such as managing smoking behaviour or alcohol reduction. This is an excellent meeting to attend with permission from the person leading such a forum, and can also be an opportunity to meet members of the community and their families and carers.


When exploring the concept of needs assessment within your university lectures, a reference may have been made to Bradshaw’s Taxonomy of Need (1972), which describes different types of need. These are:



For appropriate services to be developed, healthcare practitioners need to take account of all ‘types’ of need. An example which illustrates these three different needs could be:




National targets for improving health


National targets often underpin government health policy and may be enacted through legislation, for example the ban on smoking in any public place in the UK, such as cinemas, restaurants, university campuses and pubs, with many places not even having a dedicated space for smoking and smokers. They clearly impact on healthcare delivery within local communities. These targets for health improvement are normally identified because they constitute a major public health issue, which has not been resolved through existing interventions. Smoking prevention and cessation is one of these.



Activity


Identify the key national targets for improving the health of the population in the part of the UK that you are based. You will find it helpful to access the government websites referred to in Chapter 1.


Discuss with your mentor how these targets are addressed locally and the services that are in place to meet them. The practice manager at the health centre may also be able to give you information.


Identify a learning action for yourself to discuss with your mentor and how this knowledge can help you achieve your programme and NMC learning outcomes with regards to public health and wellbeing.


The Scottish Government (2007) has developed a set of core objectives and measures for the NHS known as HEAT targets, which include work within areas such as mental health, focusing on decreasing the use of antidepressants utilisation, reducing suicide rates and improvements in the earlier diagnosis and management of clients with dementia.


A health needs assessment approach enables practitioners to critically examine current provision of services and how this addresses local healthcare needs. It is also an opportunity to review the contributions of all healthcare professionals in that particular aspect of care.



Activity


With guidance from your mentor, look at how a health needs assessment approach could be used for a specific client group. This could be looking at services to prevent or treat disease or services to promote health. An example could be women aged over 60 years (at risk of osteoporosis) or men over 50 (at risk of prostatic cancer).



image Consider the contributions of different healthcare practitioners in meeting the needs of this specific client group.


image You should try to include an examination of current services for this specific client group and all the best practice, newly published guidelines, which should be referred to in the future development of services. Remember you are looking at what ‘is happening’ and what ‘should be happening’, in terms of service provision, resulting in the identification of clear objectives of what changes are required and how these changes can be achieved. Try to identify what an action plan might entail for the specific client group you have chosen.


image Refer to the National Institute for Clinical Excellence’s (NICE 2005) Health needs assessment: A practical guide, at: www.nice.org.uk will assist you with this activity.


image A report of your findings could be used in your portfolio to evidence the achievement of learning outcomes relating to public health, health needs assessment and health improvement.



Meeting the needs of individual patients and their carers


In this chapter so far, you have explored assessing the needs of the community but you must also consider meeting the needs of the individual and their carers, all of whom are part of your mentor’s caseload of patients/clients. It is helpful to use the stages of the nursing process, in particular the first stage of assessment.



Assessment


Assessment is the first stage in the process of planning individualised care for the client; it requires gathering information, which can significantly influence the plan of care and assist the client to retain their independence (Holland and Whittam 2008). Approaches to assessment differ according to the clinical setting. Assessing the needs of the client within the home environment, for example may help them and their carers to feel more at ease and therefore more comfortable in giving an honest expression of their concerns and needs. However, the home environment can also pose significant challenges such as an untidy, smelly or unclean environment, as referred to in Chapter 3. The distractions within the ‘business’ of a clinic or surgery, however, may also pose difficulties in the facilitation of a therapeutic relationship.


During your community experience, you will be aware that some individuals and their families have been known to the community nurse and to the general practice over a long period of time. The longer the duration of the nurse–patient relationship, the more conducive to developing a more holistic perspective of the person’s actual and potential needs. For example, although the district nurse may have an initial request to visit an older person to dress a venous ulcer, over a number of visits the person may disclose issues such as loneliness, difficulty with medication and mobility problems. The first visit to a client’s home can present the community nurse with an overwhelming amount of information and great skill is required to be able to identify the client’s key issues and concerns and plan care which addresses their specific needs.



Activity


Try to use some agreed time during your community placement to review the different ways in which client’s needs are assessed. Discuss with your mentor how you might practise assessment skills, as this will contribute to achieving your learning outcomes associated with NMC competencies in the domain: Nursing practice and decision-making (NMC 2010). Ensure that you observe your mentor or member of the team undertake an assessment first and when you are undertaking one yourself under supervision, do not forget to ask the patient/client for permission to do so, explaining that you are a student nurse and also that you would value very much their feedback on how you undertook the assessment, as well as how effective your communication skills were. This inclusion of service users and carers in the assessment of student nurses is also to be encouraged as part of the assessment of skills and knowledge within the NMC 2010 standards (NMC 2010).

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  4. The context of community nursing

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Feb 19, 2017 | Posted by in NURSING | Comments Off on Assessing and addressing need in the community

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