Responsibilities of Baccalaureate-Prepared Community/Public Health Nurses

Formative and Summative Evaluations

When is nursing care with communities evaluated? Evaluation of the effectiveness of care that takes place after the interventions have been performed is known as summative evaluation because the nurse is evaluating the sum, the bottom line, the end results. Summative evaluation involves measurement of community responses to nursing care and interpretation of the degree to which planned goals were met. Summative evaluation usually consists of measurement of outcomes and goal attainment.

Summative evaluation may also take place several months or years after nursing care has been provided. This evaluation seeks to determine whether a long-term impact was made on the health status and the health responses of the community.

Formative evaluation is evaluation that occurs throughout the nursing process but before evaluation of the outcomes of care. This evaluation occurs during the formation of the nursing care and during the process of its actual delivery. In other words, formative evaluation considers the day-to-day provision of programs of nursing care. Formative evaluation allows ongoing modification of nursing practices.

In the formative example just mentioned, the nurse can take action to remediate some of the problems identified during the intervention process. For example, the nurse might take the names of participants and deliver the printed material to them at some later date. The nurse had the seniors move into a small group in the room and found and used a microphone to help with the presentation.

Community Involvement

Because the community members are involved in evaluation, at least part of the evaluation must occur in the clients’ community. Mutuality is an important aspect of evaluation. Because much of the impact of the community/public health nurse is indicated by self-care and lifestyle changes of community members, a nurse must document and validate outcomes directly with community members. Additionally, although goals have been achieved, some negative or unexpected results might also have occurred. The nurse must explore the perceptions of community members to discover and validate the meaning of the experience. Determining how satisfied community members are with both the outcomes and the nursing interventions is important.

Stakeholders are individuals who have expectations about nursing care but who are not directly involved in its delivery. For example, there are individuals whose approval was necessary, those who contributed money or supplies, those who volunteered to assist, and those (such as competitors) for whom the presence of nursing services had an impact. Stakeholders in a community immunization campaign might be the county health officer, a retail pharmacist who donates syringes, a local pediatrician who is concerned about financial competition, and parents of persons who were immunized. Community health/public nurses need to identify the stakeholders and invite them to participate in evaluation.

Standards for a Good Evaluation

Evaluation of Outcome Attainment

When evaluating the health of a community, more than the outcomes of the population must be considered. Because the interaction of people in their environment facilitates or hinders health, variables such as the presence of health services, the satisfaction and acceptance of such programs, the presence of policies, and a harmonious balance with the environment must also be considered. Each of these variables, which are used as an outcome measure of the health of populations or communities, is discussed in more detail. Each of these variables can be used as a measure of the effectiveness of specific community/public health nursing interventions.