Types of Community Assessment (Nursing)

00:01 This presentation is all about different types of community assessments.

00:06 Now, this image should look very familiar to you.

00:08 This is the nursing process.

00:10 And no matter what type of nursing we practice, the first step is always conducting an assessment.

00:15 This is no different in public health nursing.

00:18 However, in public health nursing, instead of assessing our patient, we assess the community, we conduct a community assessment.

00:27 Now, community assessments are conducted early in the process of the development of any sort of community intervention.

00:34 This is very similar to the assessment of a single patient.

00:37 After we collect data, we conduct an evaluation of the current situation in a community, and we compare that to the desired situation of the community.

00:47 From there, we make a plan to move the community towards the desired outcome.

00:52 This should sound similar, it's the same way you collect information about a patient and then use that information to make a plan to improve the health of your patient.

01:01 A community assessment can be used for many purposes, we can use it to create an action plan, we can use a community assessment to establish objectives for community level intervention, we can use our data to select strategies to address a specific health concern within a community.

01:19 We can use our data to establish a baseline for evaluating changes in community health.

01:24 And finally, we use a community assessment to identify partners and resources that can be used and working toward a common goal.

01:32 Ultimately, our community assessments are used to mobilize a community into action, identifying and matching the skills of community members with resources of local organizations.

01:43 The first thing to understand as you begin a community assessment is that community members are the experts.

01:49 They live in the community.

01:50 They are experts on where they live.

01:52 All community members have skills, abilities and talents that they can contribute to the community.

01:59 A Healthy Community is truly built upon the talents and resources of its members.

02:04 So now that we've established the purpose and key principles of community assessment, let's take a look at different types of community assessments.

02:12 First, we have the windshield survey, then a comprehensive assessment, a problem oriented assessment, and finally, a community subsystem assessment.

02:24 Let's start first with our windshield survey.

02:26 This is George, our public health nurse, he's about to start a community assessment first by doing a windshield survey.

02:33 A windshield survey is an informal assessment of a community where you go out into the community and you use all of your senses to gather data, to gather data, to get a sense of what it feels like to live in the community.

02:44 But before you can start your windshield survey or any other type of community assessment, you first have to define your area.

02:51 What area will you assess? So first, define your area.

02:56 Next, you need a plan.

02:57 Where will you go? Who will you talk to? How will you get there? You have to make a determination if you're going to go on and foot or if you're going to ride around in a car.

03:07 Now if you do decide to drive, it's important that you work with a team, one person will need to drive, one person will need to navigate and any other passengers can be note takers.

03:17 As you can imagine, doing this on your own in a car would be nearly impossible and pretty dangerous.

03:22 So if you're going to use a car to do your windshield survey, make sure you're working with the team.

03:27 Now I mentioned using all of your senses.

03:30 You use all of your senses to take in everything around you.

03:34 So what do you see? When you look around, do you see a lot of green spaces? Do you see trees? Do you see parks? Other recreational areas? Do you see well maintained houses? Frequently vacant lots.

03:48 It's also important to understand what you do not see.

03:51 Maybe you saw several parks, but no one was using them.

03:54 Maybe you drove the entire neighborhood saw several convenience stores but no true grocery store.

03:59 The absence of community resources is just as important as the availability of community resources.

04:06 So moving on with our senses, what do you smell? When you get out of your car? Or when you're walking down the street, do you smell air pollution? Does the airfield clean when you breathe it in? What do you hear? Do you hear traffic? Do you hear noise from factories? Or do you hear birds chirping? Do you hear children playing? Often a windshield survey is the very first step in our community assessment process.

04:29 It's quick, it's informal, it's a way for you to really get a sense of the community.

04:34 Now this is similar to when you walk into a patient room and just kind of take it all in.

04:38 You look around, you see who's there, who's not there, you might use your sense of smell to learn about the patient.

04:44 Now again, this is just the beginning.

04:46 You never rely only on your observations when you walk into a patient room to develop your entire plan of care, but this gives you a place to start.

04:54 The same is true for a windshield survey.

04:57 Next we have our Comprehensive Assessment.

05:00 This includes several components or what we call subsystems and it builds upon your windshield survey.

05:06 Consider this your comprehensive head to toe of your patient.

05:09 Now to do this, you need to do more than just observe, you reflect on your observations to determine what types of data you need to collect.

05:17 Where are the holes, where are the gaps, you can use publicly available data, key informant interviews, surveys, organizational documents, anything you can find to fully assess the community and all of these areas.

05:29 So let's take a look at each subsystem.

05:33 We'll start first with communication.

05:36 What languages are spoken in the community.

05:38 So when you were doing your windshield survey and using your sense of hearing, what did you hear? How do people communicate with each other? Is there a community newspaper? How do people communicate via social media? What do billboards say? Next, we have demographics.

05:54 So who lives in the community? Who served by the organization that you're working with? Here, you could look at characteristics such as age, race, gender, ethnicity.

06:06 Our next subsystem is amenities and open space.

06:09 So this is a great place to really reflect back on your windshield survey.

06:13 Did you see a lot of parks? If so, you might go to the local park district website and see what services they offer.

06:19 Maybe you look at Google Maps to see what amenities such as gyms or movie theaters are in the area.

06:26 Next, we have transportation.

06:28 Again, maps are really helpful here.

06:30 When you're out in the community.

06:31 Did you see any buses? Did you see any train tracks? If so you can use a map to figure out where those buses stop, where those train lines can take residents? Did you see bike lanes? Did you see people walking? Are the sidewalks in good repair? You could even do a little research to figure out the last time that the sidewalks were fixed.

06:51 Next we have safety.

06:53 Here you'll look up things such as crime rates in the community, you will get the availability of police officers and firefighters.

07:01 Next, we have commercial buildings and businesses.

07:05 Here we look at the different types of retail stores and other services that are available in the community.

07:10 Are there shopping malls, strip malls, small locally owned neighborhood stores? What types of goods do they sell? Do you see convenience stores? Do you see grocery stores.

07:22 Next we have government offices.

07:24 Here you'll look for things such as town halls, police stations, fire stations, courthouses, even post offices are considered government offices.

07:35 Here we have health services.

07:37 Now before you begin to collect data about the availability of health services within a community, it's important to understand the health outcomes for the community.

07:45 So here, you'll collect data about morbidity and mortality rates for community members.

07:50 This will allow you to understand the health concerns that they face most often.

07:56 Then you'll look for the availability of health services.

07:58 So you'll look for pharmacies, public clinics, private clinics, physician's offices, you'll look for services such as mental health counseling, dental offices, maybe even drug and alcohol treatment facilities.

08:13 Here we have education.

08:15 Now, before you assess the educational system in a community, it's important to understand educational attainment of community members.

08:22 How many community members graduated high school? How many have gone on to some sort of college? Once you have that data, then you can assess the local education system? Are their elementary schools, private, public? How do they perform? Is there availability of high schools or technical schools within the community? Next, we have residential areas.

08:44 What types of residences do you see in the community? Are there large apartment buildings, condominiums, row homes, single family houses? And what's the condition? Are they newly built? Are they older? Are they well or poorly maintained? Here we have religion.

09:02 The first thing to understand here is the types of religions that are practiced by community members, then you'll want to look at religious facilities.

09:10 What do you see? Are their synagogues, churches, temples, mosques? Is there a mix of religions represented within your community? And then finally, we have the environment? What is the climate like in your community? Is there visible pollution? What's the condition of the air, of the water, of the soil? So that is our comprehensive community assessment.

09:35 This is again, similar to your comprehensive head to toe assessment of our patient, but our patient here is the community.

09:42 Now once you collect all this data, it's important to not only understand what resources are available in the community, but also to consider the accessibility.

09:51 So, when you look at residential buildings, would it be possible for someone who has a disability to access those residential buildings? What about government offices? What about shopping centers, grocery stores, all important considerations to make.

10:07 Next we have a problem oriented assessment.

10:10 Now this type of assessment includes all parts of the comprehensive assessment that we just talked about.

10:16 But, we conduct this assessment through the lens have a specific health concern.

10:21 So for example, if the health concern that we're looking at is childhood obesity, when we examine demographics, we look at demographics only for the children living in a community.

10:33 We might examine the subsystem of transportation.

10:35 But when we do so, we look at things such as the availability of bike lanes near schools, or the conditions of the sidewalks near schools.

10:43 This would give us information about transportation and how it might impact childhood obesity.

10:49 For a problem oriented assessment that's focused on childhood obesity is when we're looking at the subsystem of health services, the first thing we want to do is look at those health outcomes.

10:59 So here, we would look at the percentage of children in the community who have been diagnosed with overweight or obesity.

11:06 Then we might assess things such as the percentage of people who have insurance coverage, or those who have a primary care provider.

11:13 So again, this type of assessment still includes an assessment of all subsystems.

11:18 But the public health nurse does so, through the lens of a specific health concern.

11:23 This type of assessment is done frequently when an initial assessment points to a specific health concern, or sometimes an organization or community has a specific focus, and they want to learn more.

11:35 The final type of community assessment is called a community subsystem assessment.

11:40 Here we examine just one of the subsystems but in detail.

11:44 So here we have George, our public health nurse.

11:47 Let's say he's new to a community, and he's going to be working in the schools.

11:51 So, George is going to conduct a community subsystem assessment just of the education system within that community.

11:59 By doing so this provides him with an in depth understanding of the educational system, as well as the educational attainment of community members.

12:08 Now, this type of assessment is often done when resources are limited.

12:12 Maybe there's not enough time to assess all the subsystems.

12:15 Or maybe there's not enough money to support a comprehensive community assessment.

12:22 So where does George find all of this information? I mentioned a few specific sources when I describe the subsystems, but let's take a look at different types of data sources.

12:32 First, we have primary data.

12:34 This is the type of data that you collect by talking to people in the community.

12:38 Now remember, I said that community members are experts, they are primary sources of data.

12:44 Next, we have secondary sources of data.

12:47 These are conversations or records that are produced by people who aren't necessarily a part of the community, but know the community well.

12:55 So, maybe you talk to a health care provider who frequently works with community members, but doesn't live there.

13:02 Next, we have state and local data.

13:05 Many local health departments will share their data publicly on their websites.

13:09 This is a great source of information about your community.

13:13 The same is true for national data.

13:15 The US Department of Health and Human Services, the US Census Bureau, the CDC, all of our government agencies publish publicly available data on their websites.

13:25 This data allows us to compare what's happening in our communities, to what's happening at the national level.

13:32 Then, of course, we have international sources of data.

13:35 The World Health Organization is the best source of data for this.

13:41 And then, of course, there's a handful of other types of additional sources.

13:44 You can look to social media, you can conduct surveys, you can look at maps.

13:49 Together, all of these sources of data, give us the information that we need to make assessments about our community.

13:57 So one final note here.

13:59 No matter what type of assessment you're conducting, all community assessments should be asset based.

14:05 This means that it is essential that we focus on the assets of the community rather than the deficits.

14:10 By understanding assets, we can make plans that capitalize on the strengths to work with the community to improve their health outcomes.